Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial.
Level 2 - randomized trial
Individual randomized controlled crossover trial
PubMed 18728266 · doi:10.1001/jama.300.8.924
What was done
A randomized, double-blind, placebo-controlled crossover trial evaluated 30 adolescents aged 11 to 17 years with newly diagnosed, never-treated stage 1 essential hypertension and serum uric acid levels ≥ 6 mg/dL. Participants received allopurinol (200 mg twice daily) for 4 weeks and placebo twice daily for 4 weeks, separated by a 2-week washout period, with randomized treatment order. The main outcomes were changes in casual and 24-hour ambulatory blood pressure.
What was found
Allopurinol significantly reduced blood pressure compared with placebo. Mean change in casual systolic BP was -6.9 mm Hg (95% CI, -4.5 to -9.3) for allopurinol vs -2.0 mm Hg (95% CI, 0.3 to -4.3) for placebo (P = .009), and casual diastolic BP change was -5.1 mm Hg (95% CI, -2.5 to -7.8) vs -2.4 mm Hg (95% CI, 0.2 to -4.1; P = .05). Mean change in 24-hour ambulatory systolic BP was -6.3 mm Hg (95% CI, -3.8 to -8.9) for allopurinol vs 0.8 mm Hg (95% CI, 3.4 to -2.9) for placebo (P = .001); ambulatory diastolic BP change was -4.6 mm Hg (95% CI, -2.4 to -6.8) vs -0.3 mm Hg (95% CI, 2.3 to -2.1; P = .004). Twenty of 30 participants achieved normal BP on allopurinol vs 1 on placebo (P < .001).
Why it matters
This study provides clinical evidence that lowering uric acid with allopurinol reduces blood pressure in hyperuricemic adolescents with newly diagnosed essential hypertension.
Limits
The sample size was small (n = 30) from a single pediatric center, and the follow-up duration was short (4 weeks per treatment). Patients with stage 2 hypertension or major systemic comorbidities were excluded, and long-term efficacy and potential adverse effects were not established.
Cited by
- supports Approximately 90% of adolescents with newly diagnosed primary essential hypertension have elevated serum uric acid, compared to under 5% of normotensive controls.
- supports In a randomized, double-blind, placebo-controlled trial of adolescents with newly diagnosed primary hypertension, lowering uric acid with allopurinol normalized blood pressure in 88% of subjects compared to ~5% on placebo.
- supports Lowering serum uric acid with allopurinol significantly lowers elevated plasma renin activity in hypertensive adolescents.