Relationships between diuretic-related hyperuricemia and cardiovascular events: data from the URic acid Right for heArt Health study.


Maloberti A(1)(2), Bombelli M(2)(3), Facchetti R(2), Barbagallo CM(4), Bernardino B(5), Rosei EA(6), Casiglia E(7), Cicero AFG(8), Cirillo M(9), Cirillo P(10), Desideri G(5), D'elia L(11), Dell'Oro R(2)(3), Ferri C(5), Galletti F(11), Giannattasio C(1)(2), Loreto G(10), Iaccarino G(12), Lippa L(13), Mallamaci F(14), Masi S(15), Mazza A(16), Muiesan ML(6), Nazzaro P(17), Parati G(2)(18), Palatini P(7), Pauletto P(19), Pontremoli R(20), Quarti-Trevano F(2)(3), Rattazzi M(19)(21), Rivasi G(22), Salvetti M(6), Tikhonoff V(21), Tocci G(23)(24), Ungar A(22), Verdecchia P(25), Viazzi F(20), Volpe M(23)(24), Virdis A(15), Grassi G(2), Borghi C(8); Working Group on Uric Acid, Cardiovascular Risk of the Italian Society of Hypertension (SIIA).
Author information:
(1)Cardiology IV, 'A. De Gasperis' Department, Ospedale Niguarda Ca' Granda.
(2)School of Medicine and Surgery, Milano-Bicocca University, Milan.
(3)Clinica Medica, San Gerardo Hospital, Monza.
(4)Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo.
(5)Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila.
(6)Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
(7)Studium Patavinum, Department of Medicine, University of Padua, Padua.
(8)Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna.
(9)Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples.
(10)Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, 'Aldo Moro' University of Bari, Bari.
(11)Department of Public Health, 'Federico II' University of Naples.
(12)Department of Advanced Biomedical Sciences, 'Federico II' University of Naples, Naples.
(13)Italian Society of General Medicine
(SIMG), Avezzano, L'Aquila.
(14)CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria.
(15)Department of Clinical and Experimental Medicine, University of Pisa, Pisa.
(16)Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo.
(17)Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari.
(18)Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan.
(19)Medicina Interna I, Ca' Foncello University Hospital, Treviso.
(20)Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa.
(21)Department of Medicine, University of Padua, Padua.
(22)Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence.
(23)Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome.
(24)IRCCS Neuromed, Pozzilli.
(25)Hospital S. Maria della Misericordia, Perugia, Italy.


OBJECTIVE: Although the relationship between hyperuricemia and cardiovascular events has been extensively examined, data on the role of diuretic-related hyperuricemia are still scanty. The present study was designed to collect information on the relationship between diuretic-related hyperuricemia and cardiovascular events. METHODS: The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, observational cohort study involving data on individuals recruited from all the Italy territory under the patronage of the Italian Society of Hypertension with an average follow-up period of 122.3 ± 66.9 months. Patients were classified into four groups according to the diuretic use (yes vs. no) and serum uric acid (SUA) levels (higher vs. lower than the median value of 4.8 mg/dl). All-cause death, cardiovascular deaths and first cardiovascular event were considered as outcomes. RESULTS: Seventeen thousand, seven hundred and forty-seven individuals were included in the analysis. Mean age was 57.1 ± 15.2 years, men were 45.3% and SBP and DBP amounted to 144.1 ± 24.6 and 85.2 ± 13.2 mmHg. 17.2% of individuals take diuretics of whom 58% had SUA higher than median value. Patients with hyperuricemia without diuretic use served as reference group. In multivariate adjusted analysis (sex, age, SBP, BMI, glucose, total cholesterol, and glomerular filtration rate) individuals with hyperuricemia and diuretic use exhibit a similar risk for the three outcomes as compared with the reference group. CONCLUSION: Our study showed that diuretic-related hyperuricemia carry a similar risk of cardiovascular events and all-cause mortality when compared with individuals that present hyperuricemia in absence of diuretic therapy.