RT Journal
A1 Feig DI, Soletsky B, Johnson RJ
T1 Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: A randomized trial
JF JAMA
JO JAMA
YR 2008
FD August 27
VO 300
IS 8
SP 924
OP 932
DO 10.1001/jama.300.8.924
UL http://dx.doi.org/10.1001/jama.300.8.924
AB 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 ≥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