Science Journal of Clinical Medicine
Volume 4, Issue 4, July 2015, Pages: 76-79

Prevalence of Hyperuricemia (HU) in Arterial Hypertension

Bâ Hamidou Oumar1, Menta Ichaka1, Maiga Asmaou Kéita2, Daou Adama3, Diall Ilo Bella4, Coulibaly Souleymane4, Doumbia Coumba Thiam3, Daffé Sanoussi3, Sidibé Noumou1, Sangaré Ibrahima1, Millogo Georges Rosario Christian5, Touré Mamadou1, Sidibé Salimata4, Diarra Mamadou Bocary3

1University Hospital «Gabriel Touré», Cardiology, Bamako, Mali

2University Hospital «Le Luxembourg », Cardiology, Bamako, Mali

3National support center for the fight against the disease, Bamako, Mali

4University Hospital «Point G», Cardiology, Bamako, Mali

5University Hospital «Yalgado Ouedraogo», Cardiology, Ouagadougou, Burkina, Faso

Email address:

(B. H. Oumar)

To cite this article:

Bâ Hamidou Oumar, Menta Ichaka, Maiga Asmaou Kéita, Daou Adama, Diall Ilo Bella, Coulibaly Souleymane, Doumbia Coumba Thiam, Daffé Sanoussi, Sidibé Noumou, Sangaré Ibrahima, Millogo Georges Rosario Christian, Touré Mamadou, Sidibé Salimata, Diarra Mamadou Bocary. Prevalence of Hyperuricemia (HU) in Arterial Hypertension. Science Journal of Clinical Medicine. Vol. 4, No. 4, 2015, pp. 76-79. doi: 10.11648/j.sjcm.20150404.12


Abstract: Introduction: Hyperuricemia constitutes a risk for many organs and its prevalence is high ranging from 15-20% up to 35% in developing countries. HU relation to arterial hypertension was pointed out in the end of the XIX century and is recognized as independent cardiovascular risk factor. Thus HU is less studied in our environment which justifies our work to determine prevalence and with HU associated factors among hypertensive patients followed in the Cardiology department in the Mother Child Hospital "Le Luxembourg". Methodology: It’s was a cross-sectional study in the Mother-Child Hospital "Le Luxembourg" in Bamako. All patients with complete labor tests were included making a sample of 51 hypertensive outpatients seen from July 2010 to January 2011. For any included patient, socio-demographic and biological variables were collected. In the same way a chest radiography, an ECG and an echocardiography were realized. Patients were asked about their knowledge about HU Hyperuricemia was defined as an uricemia > 420 μmol/l for men and 360 μmol/l for women. Microsoft Excel 2007 was used to gather data and SPSS version 12 to perform analyzes. Results: Mean age of the sample was 56,35 years, the sex-ratio Male: Female 0,76. Hyperuricemia, hypercreatininemia and hyperglycemia were found respectively in 66,7,33,3% and 23,5% of the cases. 78,4% of the patients had stated to have heard about hyperuricemia, 27,5% knew their hyperuricemia. The socio-demographic characteristics did not present a statistically significant difference. Conclusion: Hyperuricemia as a cardiovascular risk factor, had to be researched and managed more agressively. The very high proportion of patients with a hyperuricemia requires to detect it among hypertensive patients, to carry out an early treatment and thus to reduce the cardiovascular risk of the patient.

Keywords: Hypertension, Hyperuricemia, Cardiology, Bamako


1. Introduction

Hyperuricemia is a frequent biochemical anomaly, resulting from an excessive production of urate and/or a decreased renal excretion of uric acid. The risk of development of a gout is increased for concentrations higher than 600 μmol/l [1,2].

It constitutes a risk for many organs [3-7]. The prevalence of HU is from 15-20% by men and 5-10% among women [8], can even reach 35% by man and 8,7% by woman in the developing countries [9].

A relation between the uric acid (UA) and arterial hypertension (HT) was evoked already in the end of the XIX century [9-11].

If certain great studies minimized the role of the HU in the arterial HT [12], today HU is recognized as independent cardiovascular risk factor [4,13].

The relative risk to develop an HT increases with the uricemia, HT incidence increases approximately 7% for each increase of 14 mg/l (83 µmol/l) of uricemia (ARIC study), for each increase of 60 µmol/l of uricemia, the relative cardiovascular risk was 1,09 in man and 1,26 in woman (study NHANES). In the same way an association between serum uric acid and cardiovascular events in hypertensive women was supported, and a reduction of serum uric acid may be due by specific medicament [11].

Little is known about HU in our working environment so that this condition need to be explored and motivated this work that tries to determine the prevalence and with HU associated factors among hypertensive patients followed in the service with Cardiology with the Hospital Mother Child "Luxembourg", is the reason for this work.

2. Methodology

The cross-sectional study was performed in the Mother-Child Hospital "Le Luxembourg" from July 2010 to January 2011

All hypertensive outpatients seen in the Mother-Child Hospital and with full clinical and labor tests data were included.

HT patients with incomplete labor tests were not included.

For any included patient, socio-demographic, cardiovascular risk factors, clinical data and biological variables were collected.

Body mass index (BMI) was calculating using weight in Kg and height in m as weight/height2. Overweight, Obese and underweight were defined as BMI resp. ≥ 25 Kg/m2, ≥ 30 Kg/m2 and < 18,5.

In the same way data on chest radiography, electrocardiogram (ECG) and an echocardiography were realized.

HU was defined as a serum uric acid level > 420 μmol/l for men and 360 μmol/l for women.

A qualitative appreciation (normal or anormal) was used for uric acid, glycemy, serum creatinine as well for radiographic, electrocardiographic and echocardiographic data. study.

Further patients were asked about their knowledge about HU using 5 questions:

Have you heard about hyperuricemia

Do you have an hypericemia?

If yes how long ?

Do you take medication against hyperuricemia ?

If yes which medications?

Microsoft Excel 2007 was used to gather data and SPSS version 12 to perform analyzes.

Analyzes were performed in 2 stages : a first descriptive part and a second analytic part.

Significantly were tests for a p-value of less than 0,05

Patients had to freely choose to be included or not without any consequence about their further management.

3. Results

3.1. Descriptive Study

The sample size was 51 hypertensive patients, with an mean age of 56,35 years and an mean duration of HT of 10,73 months. The others characteristics of the sample are shown in Table 1.

Patients aged from 46 - 60 and those over 60 years represented the majority with respectively 39,2%,37,3% and the sex ratio Male: Female was 0,76 (Table 2).

47,1% had HT diagnosed for less than 6 months, Diabetes and Gout were found in respectively 15,7% and 5,9%. Cardiac disease was found in 3,9% of all cases and obese patients made 41,2% of the sample (Table 3).

HU, high serum creatinine and hyperglycemia were found respectively in 66,7,33,3% and 23,5% of all cases, while 27,5% had a cardiomegaly on chest radiography and 92,2% a pathological echocardiography (Table 4).

78,4% of the patients had stated to have heard about HU, 27,5% knew their hyperuricemic condition.

Table 1. sample characteristics of 51 hypertensive patients with HU.

Variables Minimum Mean Maximum standard Deviation
Age 28,00 56,35 79,00 12,82
HT duration(months) 1,00 10,73 40,00 9,65
Weight (Kg) 45,00 82,53 125,00 19,73
Height (cm) 145,00 163,73 190,00 8,39
BMI* (Kg/m2) 16,53 30,84 48,07 7,15
Systolic pressure (mmHg) 100,00 163,14 240,00 29,97
Diastolic pressure (mmHg) 70,00 98,02 169,00 14,74
HR** (/min) 45,00 85,90 116,00 16,96
Uricemia (mmol/l) 59,50 440,07 833,00 164,32

*: body mass index; ** Heart Rate

Table 2. socio-demographic variables distribution in the sample of 51 hypertensive patients with HU.

Variables Number Percentage
Age group (years ) < 30 2 2,0
31-45 10 19,6
46-60 20 39,2
>= 61 19 37,3
Sex Male 22 43,1
Female 29 56,9
Profession Civil servant 13 25,5
Trader 5 9,8
House wives 21 41,2
Elderly person 6 11,8
Other 6 11,8
Residence Bamako 41 80,4
Out of Bamako 10 19,6

Table 3. Medical history and cardiovascular risk factor distribution in the sample of 51 hypertensive patients with HU.

Variables Number %
HT duration ( months) < 6 24 47,1
7-12 11 21,6
13-18 1 2,0
> 18 15 29,4
BMI Underweight 13 25,5
Normal 5 9,8
Obese 21 41,2
Overweight 12 23,5
Diabetes mellitus No 43 84,3
Yes 8 15,7
Gout No 48 94,1
Yes 3 5,9
Heart disease No 49 96,1
Yes 2 3,9
Others* Yes 31 60,8
No 20 39,2

*Gastro-duodenal ulcer, Asthma bronchiale, functional Colopathy

Table 4. Labor tests data evaluation in the sample.

Variables N %
Uricemia Anormal 34 66,7
Normal 17 33,3
Creatininemia (n=47) Normal 30 63,8
Anormal 17 36,2
Glycemia (n=44) Normal 32 72,7
Anormal 12 27,3
CTI* (n=30) Normal 16 53,3
Anormal 14 46,7
ECG** (n=51) Normal 29 56,9
Pathological 22 43,1
Echographie cardiaque Pathological 47 92,2
Normal 04 07,8

* Cardio-thoracic index **Left ventricular hypertrophy

3.2. Analytical Study

The socio-demographic variables did not present a statistically significant difference. HU seemed more prevalent among female sex, in the age group >= 61 years and among Housewives with respectively 75,9% (p=0,11), 68,4% (p=0,87) and 71,4% (p=0,98).

HU was found in 83,3% among obese patients (p=0,64), 64,1% of the sedentaries (p=0,48) and 83,3% of the diabetes patients (p=0,25).

71,4% of the patients having a cardiac enlargement and 54,5% with a left ventricular hypertrophy had an HU (p=0,39 respectively 0,11) (Table 5).

We did not find in the sample patients presenting an anomaly of LDL-Cholesterol or triglycerides.

Table 5. HU associated factors in the sample.

Variables HU P
No Yes
Age (years) < 30 0,0 100,0 0,87
31-45 40,0 60,0
46-60 35,0 65,0
>= 61 31,6 68,4
Sex Male 45,5 54,5 0,11
Female 24,1 75,9
Profession Civil servant 38,5 61,5 0,98
Trader 40,0 60,0
House wives 28,6 71,4
Elderly person 33,3 66,7
Other 33,3 66,7
BMI* Underweight 100,0 0,0 0,64
Normal 37,5 62,5
Overweight 26,7 73,3
Obese 40,0 60,0
Morbid Obese 16,7 83,3
Sedentarity No 25,0 75,0 0,48
Yes 35,9 64,1
Diabetes mellitus No 34,4 65,6 0,25
Yes 16,7 83,3
Cardiomegaly No 43,8 56,3 0,39
Yes 28,6 71,4
ECG** Normal 24,1 75,9 0,11
Abnormal 45,5 54,5

* Body mass index, ** Electrocardiogram

4. Discussion

Our study was realized on a sample of adults patients with a mean age of 56,35 years.

HU prevalence was 66,7% (75,9% in female sex and 35,3% in male sex) which is consistent with literature data ranging from 25 to 75% [10,15] and the HU is considered as cardiovascular risk factor [9-11,13,14], requiring a more aggressive management of patients having an HU.

The mean uricemia was 440,067 (413,01 in female and 475,73 in male).

We did not find a statistically significant difference in age groups, sex and profession.

HU is generally associated with others metabolic disorders [4,9,16,17]. We could not highlight such relations, probably because of relatively small size of our sample.

If HU was frequent in our sample (4) only 27,5% of the patients were informed about this anomaly even if 78,4% of the patients stated to have heard about HU. This fact underlines the ignorance of the cardiovascular risk factors and thus the difficulty related to their management and thus requires broader information of the patients on these factors.

In addition the high percentage of patients with an HU implies to seek it among HT patients and to avoid the potentiation of the cardiovascular risk factors.

The high proportion of HT patients with HU pointed out the need for large sample studies to better characterize HU.

5. Conclusion

Hyperuricemia as a cardiovascular risk factor had to be researched and managed more agressively. The very high proportion of patients with a HU requires to detect it among hypertensive patients, to carry out an early treatment and thus to reduce the cardiovascular risk of the patient.


References

  1. Scorr JT. Asymptomatic hyperuricaemia. British Medical Journal (Clinical research ed). 1987;294(6578):987-988.
  2. Snaith ML. Gout, Hyperuricaemia, And Crystal Arthritis BMJ : British Medical Journal. 1995;310(6978):521-524.
  3. Slot O. Hyperuricemia (Abstract). Ugeskr Laeger. 1994 ;156(16):2396-401.
  4. Feig DI, Kang DH, Johnson RJ., Uric acid and cardiovascular risk. N Engl J Med 2008; 359:1811-21.
  5. Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA.Hyperuricemia and Risk of Stroke: A Systematic Review and Meta-analysis. Arthritis Rheum. 2009 July 15; 61(7): 885–892 doi:10.1002/art.24612
  6. Krishnan E.Hyperuricemia and incident heart failure. Circ Heart Fail. 2009 November ; 2(6): 556–562.
  7. Hurtes X, Meria P.Atteintes uro-néphrologiques des hyperuricémie.Presse Med (2011), doi:10.1016/j.lpm.2011.05.006
  8. Mijiyawa M, Bouglouga OE. Hyperuricémie et goutte en zone intertropicale.Revue du rhumatisme 2003 (70):152-156
  9. Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccaud F and Burnier M.Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country.BMC Public Health 2004, 4:9.
  10. Hadjeres S, Saudan P. L’Hyper uricémie dans l’hypertension artérielle et l’insuffisance rénale : facteur causal ou épiphénomène? Revue médicale Suisse, numéro : 3192 : 1- 6. Visité mai 2011.www.medhyg.ch/formation/article.php3?sid=33881
  11. HØieggen et al:Serum uric acid in the LIFE study. Kidney International 2004; 65: 1041-49
  12. Culleton BF, Larson MG, Kannel WB, Levy D.,Serum uric acid and risk for cardiovascular disease and death:The Framingham heart study. Ann Intern Med 1999; 131:7-13.
  13. Allard A, Bardin T. Hyperuricémie et risque cardiovasculaire(abstract ).L'actualité rhumatologique 2009.http://www.em-consulte.com/article/278000/hyperuricemie-et-risque-cardiovasculaire.Doi : 10.1016/B978-2-8101-0150-4.00011-4
  14. Mene P, Punzo G. Uric acid: Bystander or culprit in hypertension and progressive renal disease? (abstract).J Hypertension 2008; 26: 2085 – 92
  15. Deléaval P, Burnier M. L’hyperuricémie dans l’hypertension artérielle: quelle implication? Revue Médicale Suisse 2005; 32.http://www.revmed.ch/rms/2005/RMS-32/30649. Accessed on 22.04.15
  16. Chen et al.Relationship between hyperuricemia and metabolic syndrome.J Zhejiang Univ Sci B 2007; 8(8):593-598
  17. Sui X, Church TS, Meriwether RA, Lobelo F and Blair SN. Uric Acid and the Development of Metabolic Syndrome in Women and Men. Metabolism. 2008;57(6): 845–852.

Article Tools
  Abstract
  PDF(183K)
Follow on us
ADDRESS
Science Publishing Group
548 FASHION AVENUE
NEW YORK, NY 10018
U.S.A.
Tel: (001)347-688-8931