Uric-acid predictive performance analysis for subclinical organ damage in essential hypertensive patients

Serum uric acid (SUA) has emerged as a cardiovascular risk marker beyond gout and renal disease. Evidence from the URRAH (Uric Acid Right for Heart Health) project has established that mortality risk increases at SUA concentrations lower than the traditional hyperuricemia threshold. However, the relationship between SUA, renal function-adjusted indices, and subclinical organ damage across different degrees of adiposity in hypertension remains incompletely understood. The present study aims at correlate Serum uric acid (SUA), and SUA/estimated glomerular filtration rate (eGFR) ratio with hypertension-mediated organ damage in adult patients with essential hypertension.

We studied 326 patients with hypertension, stratified by body mass index (BMI). Echocardiography and laboratory analyses assessed target-organ damage, including left ventricular mass index (LVMI) and albuminuria. Patients were categorized according to previously validated SUA cutoffs (5.6 mg/dL for cardiovascular mortality). SUA and SUA/eGFR increased progressively across BMI groups (p < 0.001). The proportion of patients above the URRAH cardiovascular-risk threshold (5.6 mg/dL) rose from 35.8 % in normal-weight to 60.3 % in obese individuals. Both SUA and SUA/eGFR correlated with LVMI and albuminuria (p < 0.01). The predictive performance for cardiac remodeling was strongest in normal-weight patients (AUC = 0.74 for SUA/eGFR).

In essential hypertension, elevated SUA and higher SUA/eGFR ratios are associated with early cardiac and renal structural changes, even at levels below the conventional definition of hyperuricemia. Obesity amplifies urate exposure but attenuates its independent predictive value, suggesting complex metabolic interactions. These findings support adopting lower, cardiovascular-oriented SUA thresholds and composite indices such as SUA/eGFR in risk assessment of hypertensive patients.