Uric acid is a risk factor for cardiovascular disease. We investigated the relationship between the change of urinary albumin excretion (UAE) and the changes of serum uric acid (SUA) during antihypertensive treatment in hypertensive patients with microalbuminuria as a subanalysis of the results of the NICE Combi (Nifedipine and Candesartan Combination) Study.Design and Method:
A total of 86 subjects with essential hypertension with microalbuminuria (UAE < 300 mg•g-1 creatinine) were randomly assigned in a double-blind manner to a combination therapy group (standard-dose candesartan at 8 mg/day plus controlled-release (CR) nifedipine 20 mg/day) (n = 42) or an up-titrated monotherapy group (candesartan 12 mg/day) (n = 44) for 8 weeks of continuous treatment after initially receiving standard-dose candesartan (8 mg/day) monotherapy for 8 weeks (initial treatment).Results:
After 8weeks, blood pressure was significantly reduced in both groups compared with at the end of initial treatment. The UAE was significantly reduced only in the N group (N group: 56.7 ⇒ 31.0 mg/gCr, P = 0.02, A group: 51.1 ⇒ 55.1 mg/gCr, NS). The SUA was not reduced in both groups, whereas reduction of SUA after 8 weeks of double-blind treatment was significantly and positively correlated with reduction of UAE and diastolic blood pressures after 8 weeks of double-blind treatment only in the N group.Conclusions:
These findings show that combination therapy with standard-dose candesartan and nifedipine CR is more effective than up-titrated candesartan monotherapy for reducing blood pressure and improving UAE in accordance with SUA, and strongly suggest that the combination of an angiotensin II receptor blocker and long-acting calcium channel blocker is beneficial in hypertensive patients with microalbuminuria and hyperuricemia.