ESPE Abstracts

Background: Hyperuricaemia has been associated with increased risk of metabolic syndrome in adults and children. Elevation in serum uric acid (SUA) is hypothesized to be a critical initiator of the development of essential hypertension. The exact relationship between SUA and blood pressure (BP) has not been established in the pediatric population. We conducted a systematic review to evaluate the association between SUA and BP in well, obese/overweight and hypertensive children and adolescents.

Methodology: A PRISMA-compliant systematic review of major databases (Pubmed, MEDLINE, Embase and Cochrane) was conducted using the key concepts “uric acid”, “blood pressure” and “paediatrics”. Articles were selected based on predefined criteria. Quality appraisal of articles was done using JBI critical appraisal tools. Data extracted were categorized into well, obese/overweight or hypertensive cohorts. Meta-regression was conducted for studies where primary numerical data on SUA and BP were reported.

Results: This systematic review identified 1203 articles, where 68 articles comprising 67,620 patients fulfilled inclusion and exclusion criteria. In well children (n=58,180), 36 of 42 studies showed a significant association between SUA-BP. In obese/overweight children (n=7,566), 15 of 20 studies demonstrated significant associations between SUA-BP while 12 of 14 studies showed a positive association between SUA-BP in children with hypertension (n=1,874). The meta-regression analysis conducted included data from well (23 studies), obese/overweight (11 studies) and hypertensive (8 studies) cohorts. A significant association between SUA and diastolic BP (DBP) was found only in the hypertensive cohort, with beta coefficient of 15.6 (95% confidence interval 8.2 – 23.0, P-value<0.005), even after adjusting for age. There was no significant association between SUA and systolic BP in the same cohort. In addition, there was no association between SUA-SBP or SUA-DBP in well children, obese children or when all cohorts were combined in the meta-regression, though data for this analysis only accounted for 35 of the 68 studies included.

Conclusion: Positive associations between SUA and BP have been reported in many studies involving well, obese and hypertensive children. When available primary data from a subset of these studies were analyzed in a meta-regression, a clear association between SUA-DBP was found only in children with hypertension. Large multinational longitudinal studies may be required to clearly establish the SUA-BP relationship for well, obese and hypertensive paediatric cohorts. This would allow specific strategies targeting SUA control in the prevention and treatment of hypertension in groups in which SUA confers a higher risk of hypertension.