Document Detail


Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial.
MedLine Citation:
PMID:  18728266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Hyperuricemia is a predictor for the development of hypertension and is commonly present in new-onset essential hypertension. Experimentally increasing uric acid levels using a uricase inhibitor causes systemic hypertension in animal models.
OBJECTIVE: To determine whether lowering uric acid lowers blood pressure (BP) in hyperuricemic adolescents with newly diagnosed hypertension.
DESIGN, SETTING, AND PATIENTS: Randomized, double-blind, placebo-controlled, crossover trial (September 2004-March 2007) involving 30 adolescents (aged 11-17 years) who had newly diagnosed, never-treated stage 1 essential hypertension and serum uric acid levels > or = 6 mg/dL. Participants were treated at the Pediatric Hypertension Clinic at Texas Children's Hospital in Houston. Patients were excluded if they had stage 2 hypertension or known renal, cardiovascular, gastrointestinal tract, hepatic, or endocrine disease.
INTERVENTION: Allopurinol, 200 mg twice daily for 4 weeks, and placebo, twice daily for 4 weeks, with a 2-week washout period between treatments. The order of the treatments was randomized.
MAIN OUTCOME MEASURES: Change in casual and ambulatory blood pressure.
RESULTS: For casual BP, the mean change in systolic BP for allopurinol was -6.9 mm Hg (95% confidence interval [CI], -4.5 to -9.3 mm Hg) vs -2.0 mm Hg (95% CI, 0.3 to -4.3 mm Hg; P = .009) for placebo, and the mean change in diastolic BP for allopurinol was -5.1 mm Hg (95% CI, -2.5 to -7.8 mm Hg) vs -2.4 (95% CI, 0.2 to -4.1; P = .05) for placebo. Mean change in mean 24-hour ambulatory systolic BP for allopurinol was -6.3 mm Hg (95% CI, -3.8 to -8.9 mm Hg) vs 0.8 mm Hg (95% CI, 3.4 to -2.9 mm Hg; P = .001) for placebo and mean 24-hour ambulatory diastolic BP for allopurinol was -4.6 mm Hg (-2.4 to -6.8 mm Hg) vs -0.3 mm Hg (95% CI, 2.3 to -2.1 mm Hg; P = .004) for placebo. Twenty of the 30 participants achieved normal BP by casual and ambulatory criteria while taking allopurinol vs 1 participant while taking placebo (P < .001).
CONCLUSIONS: In this short-term, crossover study of adolescents with newly diagnosed hypertension, treatment with allopurinol resulted in reduction of BP. The results represent a new potential therapeutic approach, although not a fully developed therapeutic strategy due to potential adverse effects. These preliminary findings require confirmation in larger clinical trials.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00288184.
Authors:
Daniel I Feig; Beth Soletsky; Richard J Johnson
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  300     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-27     Completed Date:  2008-09-02     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  924-32     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00288184
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Allopurinol / pharmacology,  therapeutic use*
Blood Pressure / drug effects*
Cross-Over Studies
Double-Blind Method
Enzyme Inhibitors / pharmacology,  therapeutic use*
Female
Humans
Hypertension / complications*,  drug therapy
Hyperuricemia / complications*,  drug therapy*
Male
Uric Acid / blood
Xanthine Oxidase / antagonists & inhibitors*
Grant Support
ID/Acronym/Agency:
5 K23 DK064587/DK/NIDDK NIH HHS; HL-68607/HL/NHLBI NIH HHS; R01 HL068607/HL/NHLBI NIH HHS; R01 HL068607-07A2/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Enzyme Inhibitors; 268B43MJ25/Uric Acid; 63CZ7GJN5I/Allopurinol; EC 1.17.3.2/Xanthine Oxidase
Comments/Corrections
Comment In:
Nefrologia. 2009;29(6 Suppl):30-2   [PMID:  20221221 ]
JAMA. 2009 Jan 21;301(3):270; author reply 270-1   [PMID:  19155448 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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