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Bidirectional Association between Self-Reported Hypertension and Gout: The Singapore Chinese Health Study
An Pan1, Gim Gee Teng2, Jian-Min Yuan3
1Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Insights
Hypertension and gout have a two-way link. High blood pressure increases gout risk, and gout slightly raises hypertension risk, particularly in normal-weight women.
Area of Science:
- Cardiovascular epidemiology
- Metabolic disease research
Background:
- The relationship between hypertension and gout is suspected to be bidirectional.
- Prospective cohort studies investigating this association are limited.
Purpose of the Study:
- To prospectively examine the bidirectional association between hypertension and gout in a Singaporean Chinese cohort.
- To explore potential effect modification by obesity and sex on this relationship.
Main Methods:
- Analysis of data from the Singapore Chinese Health Study (SCHS) follow-up I and II.
- Inclusion of participants free of heart disease, stroke, and cancer at baseline.
- Use of Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals.
Main Results:
- Hypertension was associated with an 88% increased risk of developing gout (HR 1.88).
- Gout was associated with an 18% increased risk of developing hypertension (HR 1.18).
- The bidirectional association was stronger in normal-weight individuals and modified by sex.
Conclusions:
- The study suggests a bidirectional relationship between hypertension and gout in Singapore Chinese adults.
- Interactions with obesity and sex warrant further investigation.
Abstract:
It has been hypothesized that the association between hypertension and gout is bidirectional, however, few studies have examined this in a prospective cohort. We analyzed data from the Singapore Chinese Health Study (SCHS) follow-up I (1999-2004) and II (2006-2010) interviews, when both physician-diagnosed hypertension and gout were self-reported. We included participants with data for both follow-up interviews and who were free of heart disease, stroke and cancer at follow-up I. The analysis of hypertension and risk of gout included 31,137 participants when prevalent gout cases were excluded, while the analysis of gout and risk of hypertension included 20,369 participants when prevalent hypertension cases were excluded. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The mean age at follow-up I was 60.1 (SD 7.3) years, and the average follow-up was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 682 incident cases were identified. Compared to normotensive participants, hypertensive patients had an 88% increased risk of developing gout (HR 1.88; 95% CI 1.61-2.21). In the parallel analysis, 5,450 participants reported to have newly diagnosed hypertension during follow-up. Compared to participants without gout, those with gout had an 18% increased risk of developing hypertension (HR 1.18; 95% CI 1.02-1.37). The bidirectional association was stronger in normal weight adults compared to overweight/obese individuals (Pinteraction = 0.06 and 0.04, respectively). The hypertension to gout association was stronger in women compared to men (Pinteraction = 0.04), while the gout to hypertension association was evident in women but not in men (Pinteraction = 0.02). In conclusion, our results suggest that the hypertension-gout association is bidirectional in this cohort of Singapore Chinese adults. The potential interactions of the bidirectional association with obesity and sex deserve further investigations.