Clinical Determinants of Serum Uric Acid Levels in Patients with Obesity and Hypertension

Background: Hyperuricemia is increasingly recognized as an important component of metabolic dysfunction and cardiometabolic risk, particularly in individuals with obesity and hypertension. However, the relative contribution of obesity-related metabolic disturbances and blood pressure parameters to serum uric acid levels remains incompletely understood. The aim of this study was to identify independent clinical and metabolic determinants of serum uric acid levels and to determine whether obesity or hypertension is more strongly associated with elevated serum uric acid levels. Methods: This retrospective observational study evaluated the metabolic determinants of serum uric acid levels in 370 hospitalized adults stratified according to obesity and hypertension status. Serum uric acid concentrations were measured using an enzymatic spectrophotometric method and compared across four clinical groups, and univariate and multivariable analyses were performed to identify independent determinants of serum uric acid levels. Allopurinol use was recorded and included in the multivariable analysis, whereas the effects of individual antihypertensive drug classes were not evaluated. Results: Hyperuricemia was identified in 16.8% of the cohort, with the highest prevalence observed among patients with coexisting obesity and hypertension (22%). Serum uric acid levels were higher in men than in women (median: 6.4 vs. 5.7 mg/dL; p < 0.001). In the multivariable analysis, higher expected serum uric acid levels were independently associated with higher BMI, higher ALT activity, eGFR ≤ 90 mL/min/1.73 m², and male sex, whereas older age and not receiving allopurinol were independently associated with lower expected serum uric acid levels. Each 1 kg/m² increase in BMI was associated with an approximately 0.48% higher expected serum uric acid level (95% CI: 0.19-0.78%; p = 0.001). Blood pressure parameters were not significant predictors. Conclusions: These findings suggest that excess adiposity and associated metabolic disturbances may play a more prominent role than hypertension alone in the development of hyperuricemia. Targeting obesity and metabolic risk factors may therefore represent an important strategy for reducing hyperuricemia and improving cardiometabolic health.