Allopurinol Fails to Curtail Hypertension Save

Editor's note: July 1 - 5, RheumNow is running the best of the EULAR 2019 meeting. A novel trial presented at EULAR 2019 last week assessed whether the use of urate-lowering therapy (ULT) would control hypertension in those at risk; however, results of this trial were largely negative.

Hypertension is one of the many comorbidities that plagues gout patients.

A similar trial was published in JAMA in 2008 wherein obese children with HTN and a uric acid (SUA) level > 6.0 mg/dl were treated with either placebo or allopurinol 400 mg/d. At 4 weeks the SUA dropped from a mean of 7 mg/dl to 4.2 mg/dl with allopurinol and 67% of the kids normalized their hypertension (vs only 3% with placebo). These data suggested the aggressive ULT would positively affect the kidney and resultant hypertension.

In the EULAR crossover trial, presented by Gaffo et al (OP0208), allopurinol or PBO was given to 82 young adults with prehypertension or stage 1 hypertension. It failed to significantly lower blood pressure but succeeded in significantly improving endothelial function as measured by increased flow-mediated arterial dilation (FMD).

While the latter findings are encouraging, the inability to lower BP was disappointing.  This trial differs from the aforementioned trial by age (adolescents vs young adults), obesity, or other enrollment criteria (eg, the level of SUA).

The authors of this trial noted that a BP-lowering effect with allopurinol was strongest in people who entered the study with the highest serum urate levels, greater than 6.5 mg/dL.