032 - Association of Hyperuricemia with Blood Pressure Severity, Target Organ Injury, and Cardiovascular Health in Youth Referred for Hypertension Disorders: A SUPERHERO Analysis

Publication Number: 32.3761

Landon T. Sanz, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Spring, TX, United States; Maggie Murphy, University of Kentucky College of Medicine, Lexington, KY, United States; Elizabeth A. Onugha, Baylor College of Medicine, Houston, TX, United States; Sandeep Riar, Children's Healthcare of Atlanta, Atlanta, GA, United States; Carol Vincent, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Andrew M. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: Cardiovascular health risk factors such as obesity, hyperglycemia, dyslipidemia, and target organ injury (TOI) present in youth often endure through the life course and worsen long-term outcomes. While hyperuricemia is associated with development of these risk factors, it is unclear what role uric acid plays when hypertension (HTN) is already present in youth.

Objective: Estimate the association between hyperuricemia and blood pressure (BP) severity, obesity, hyperglycemia, dyslipidemia, and TOI at baseline in youth with HTN disorders.

Design/Methods: Retrospective cross-sectional inferential analysis of baseline data from 7 sites in the Study of the Epidemiology of Pediatric HTN (SUPERHERO), a large Registry of electronic health record data of youth < 19 years old who received care from subspecialists for HTN disorders defined by ICD-10 codes from 1/1/2016–12/31/2023. Data were acquired using standardized biomedical informatics scripts and validated by manual record review. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The exposure was hyperuricemia identified by ICD-10 code E79.0. The outcomes were BP severity (measured) and obesity by body mass index percentiles per US guidelines, and hyperglycemia, dyslipidemia, and TOI to heart or kidney by ICD-10 codes. We used bivariate generalized linear models.

Results: Of the 9,356 participants, mean age was 12.8 years ±4.5, 38% were female, and 1.3% (n=119) had hyperuricemia. In unadjusted analysis, youth with hyperuricemia had 4.72 higher odds of having more cardiovascular health risk factors than those without hyperuricemia (95% CL 3.38 to 6.57). Hyperuricemia was associated with higher odds of worse HTN classification and higher risk of obesity, hyperglycemia, dyslipidemia, and TOI. Hyperuricemia was not significantly associated with measured BP or HTN, except for a -2.2-mmHg lower diastolic BP among youth ≥13 years (95% CL -4.2 to -0.2) (Table).

Conclusion(s): In this large multisite cohort of youth with HTN disorders, those with a hyperuricemia diagnosis at baseline were more likely to have several other cardiovascular health risk factors, but a lower diastolic BP among youth ≥13 years, compared to those without hyperuricemia. Ongoing steps for SUPERHERO are collecting serum uric acid laboratory values and prescription data. Future steps for SUPERHERO include a longitudinal design to understand how uric acid is associated with HTN progression over time. If validated, hyperuricemia could serve as a modifiable risk factor in improving long-term cardiovascular outcomes.

Table: Association of Hyperuricemia Diagnosis with Blood Pressure Severity, Target Organ Injury, and Cardiovascular Health at the Index Visit in Youth Referred for Hypertension Disorders