According to a report published in the August 27 issue of JAMA,
a drug that lowers uric acid levels, allopurinol, also seems to lower
blood pressure in adolescents with newly diagnosed hypertension (high
blood pressure).
Hyperuricemia - a condition characterized by higher than normal blood
levels of uric acid (a chemical found in urine and blood that results
from normal bodily processes) - is commonly associated with
hypertension. There has been some research to support uric acid’s
causal role in hypertension, but hyperuricemia is not considered a true
risk factor for hypertension as high uric acid in hypertension could be
due to several other factors. Experimental studies in laboratory
animals, however, have challenged this belief by indicating support for
a causal role of uric acid in hypertension.
To determine the effect on hypertension of a uric acid-reducing drug,
Daniel I. Feig, M.D., Ph.D. (Baylor College of Medicine, Houston) and
colleagues conducted a randomized, placebo-controlled "crossover"
trial. The researchers studied hyperuricemic adolescents (11 to 17
years old) with newly diagnosed hypertension to see if the drug
allopurinol would reduce blood pressure (BP). Feig and colleagues
randomly assigned thirty participants to receive either allopurinol or
placebo twice daily for four weeks. Following the initial
administration, there was a two week "washout" period during which the
patients did not receive anything, and then for four more weeks they
received the therapy that they had not yet received.
The investigators found that allopurinol treatment was linked to a
significant decrease in casual and ambulatory systolic and diastolic
blood pressure. During allopurinol treatment, the average decrease in
casual BP was -6.9 mm Hg systolic and -5.1 mm Hg diastolic.
Participants taking placebo only presented changes of -2.0 and -2.4,
respectively. The researchers also found that average changes in
24-hour ambulatory BP during allopurinol were -6.3 mm Hg, systolic and
-4.6, diastolic. There were slight increases in systolic BP during the
placebo phase (0.8 mm Hg) and slight decreases in diastolic BP (0.3 mm
Hg). In addition, the decrease in ambulatory BP was directly correlated
with allopurinol treatment. Remarkably, during the allopurinol phase 20
of the 30 patients reached normal BP by casual and ambulatory criteria
compared to only 1 of 30 during the placebo phase.
"The results of this study represent a potentially new therapeutic
approach, that of control of a biochemical cause of hypertension,
rather than nonspecifically lowering elevated BP. Although not
representing a fully developed therapeutic strategy, this study raises
an alternative strategy that may prove to be more effective than
currently available options," write Buy generic acomplia Feig and colleagues.
They conclude: "Despite these findings, this clinical trial is a small
one and allopurinol is not indicated for the treatment of hypertension
in adolescents or other populations. The potential adverse effects of
allopurinol, including gastrointestinal complaints and especially
Stevens-Johnson syndrome [a severe, allergic reaction], make
allopurinol an unattractive alternative to available antihypertensive
medications. More clinical trials are needed to determine the
reproducibility of the data and whether it can be generalized to the
larger hypertensive population. Nevertheless, the observation that
lowering uric acid can reduce BP in adolescents with newly diagnosed
hypertension raises intriguing questions about its role in the
pathogenesis of hypertension."
Effect of Allopurinol on Blood Pressure of Adolescents With
Newly Diagnosed Essential Hypertension: A Randomized Trial
Daniel I. Feig; Beth Soletsky; Richard J. Johnson
JAMA (2008). 300[8]:
pp. 924-932.
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Here to View Abstract
Written by: Peter M Crosta
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