Hypertension and asymptomatic hyperuricemia: algorithm of diagnostics and management (literature review)
https://doi.org/10.18705/1607-419X-2022-28-4-316-327
Abstract
Objective. To determine the diagnostic criteria for asymptomatic hyperuricemia as a cardiovascular risk factor, the need for antihypertensive therapy and urate-reducing therapy in patients with hypertension; to develop an algorithm for the management of hypertensive patients with asymptomatic hyperuricemia. Search strategy and methodology. The following key words were used for the search: “asymptomatic hyperuricemia” and “hypertension” in four databases — PubMed, Medscape, E-library Yandex.ru. Results. The review included 79 sources, including 1 monograph, 11 international and Russian guidelines, consensus documents, 67 reviews, observational, non-randomized, randomized clinical trials, their meta-analyses, requirements for uric acid blood tests. The review presents a definition, prevalence and diagnostic criteria for asymptomatic hyperuricemia, depending on the assessment method and factors affecting the concentration of uric acid, as well as the pathogenetic mechanisms of hyperuricemia. The linear relationship between uric acid level with the risk of hypertension, dyslipidemia, cardiovascular diseases and complications. The review discusses drug-induced hyperuricemia, the effect of various antihypertensive and lipid-lowering drugs on the blood concentration of uric acid, the indications for urate-reducing therapy in asymptomatic hyperuricemia. Conclusions. An algorithm for the management of patients with asymptomatic hyperuricemia and hypertension is proposed.
About the Authors
N. A. Koziolova
Perm State Medical University named after Academician E.A. Wagner
Russian Federation
Russian Federation
Natalya A. Koziolova - MD, PhD, DSc, Professor, Head, Department of Propaedeutics of Internal Diseases No. 2, Perm State Medical University named after Academician E.A. Wagner.
26 Petropavlovskaya str., Perm, 614000.
Phone: 8(342)217-20-20.
Fax: 8 (342) 217-20-21.
A. I. Chernyavina
Perm State Medical University named after Academician E.A. Wagner
Russian Federation
Russian Federation
Anna I. Chernyavina - MD, PhD, Associate Professor, Department of Propaedeutics of Internal Diseases No. 2, Perm State Medical University named after Academician E.A. Wagner.
Perm.
References
1. Mazurov VI. Clinical rheumatology. M.: GEOTAR-Media; 2021. 696 p. In Russian.
2. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020;16(7):380-390. doi:10.1038/s41584-020-0441-1
3. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 2020;79(1):31-38. doi:10.1136/annrheumdis-2019-215315
4. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. doi:10.1136/annrheumdis-2016-209707
5. Hao Y, Li H, Cao Y, Chen Y, Lei M, Zhang T et al. Uricase and horseradish peroxidase hybrid CaHPO nanoflower integrated with transcutaneous patches for treatment of hyperuricemia. J Biomed Nanotechnol. 2019;15(5):951-965. doi:10.1166/jbn.2019.2752
6. Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet. 2016;388(10055):2039-2052. doi:10.1016/S01406736(16)00346-9
7. Major TJ, Dalbeth N, Stahl EA, Merriman TR. An update on the genetics of hyperuricaemia and gout. Nat Rev Rheumatol. 2018;14(6):341-353. doi:10.1038/s41584-018-0004-x
8. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM et al. 2020 American College of Rheumatology Guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180. Erratum in: Arthritis Care Res (Hoboken). 2020;72(8):1187. Erratum in: Arthritis Care Res (Hoboken). 2021;73(3):458.
9. Virdis A, Masi S, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A et al. From the working group on uric acid and cardiovascular risk of the Italian Society of Hypertension. Identification of the uric acid thresholds predicting an increased total and cardiovascular mortality over 20 years. Hypertension. 2020;75(2):302-308. doi:10.1161/HYPERTENSIONAHA.119.13643
10. Wang R, Song Y, Yan Y, Ding Z. Elevated serum uric acid and risk of cardiovascular or all-cause mortality in people with suspected or definite coronary artery disease: a metaanalysis. Atherosclerosis. 2016;254:193-199. doi:10.1016/j.atherosclerosis.2016.10.006
11. Rahimi-Sakak F, Maroofi M, Rahmani J, Bellissimo N, Hekmatdoost A. Serum uric acid and risk of cardiovascular mortality: a systematic review and dose-response meta-analysis of cohort studies of over a million participants. BMC Cardiovasc Disord. 2019;19(1):218. doi:10.1186/s12872-019-1215-z
12. Tseng WC, Chen YT, Ou SM, Shih CJ, Tarng DC; Taiwan Geriatric Kidney Disease (TGKD) Research Group. U-shaped association between serum uric acid levels with cardiovascular and all-cause mortality in the elderly: the role of malnourishment. J Am Heart Assoc. 2018;7(4):e007523. doi:10.1161/JAHA.117.007523
13. Brucato A, Cianci F, Carnovale C. Management of hyperuricemia in asymptomatic patients: a critical appraisal. Eur J Intern Med. 2020;74:8-17. doi:10.1016/j.ejim.2020.01.001
14. Gout. Clinical recommendations [Internet]. Moscow: Association of Rheumatologists of Russia; 2018. URL: http://www.ma.cfuv.ru/docs/249620/КР%20Подагра.pdf. In Russian.
15. Zhao L, Cao L, Zhao TY, Yang X, Zhu XX, Zou HJ et al. Cardiovascular events in hyperuricemia population and a cardiovascular benefit-risk assessment of urate-lowering therapies: a systematic review and meta-analysis. Chin Med J (Engl). 2020;133(8):982-993. doi:10.1097/CM9.0000000000000682
16. Kobayashi N, Asai K, Tsurumi M, Shibata Y, Okazaki H, Shirakabe A et al. Impact of accumulated serum uric acid on coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes in patients with acute coronary syndrome. Cardiology. 2018;141(4):190-198. doi:10.1159/000496053
17. Hu X, Fu S, Wang S. Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. BMC Cardiovasc Disord. 2022;22(1):199. doi:10.1186/s12872-022-02635-4
18. Pavlusova M, Jarkovsky J, Benesova K, Vitovec J, Linhart A, Widimsky P et al. Hyperuricemia treatment in acute heart failure patients does not improve their long-term prognosis: a propensity score matched analysis from the AHEAD registry. Clin Cardiol. 2019;42(8):720-727. doi:10.1002/clc.23197
19. Zhong C, Zhong X, Xu T, Xu T, Zhang Y. Sex-specific relationship between serum uric acid and risk of stroke: a doseresponse meta-analysis of prospective studies. J Am Heart Assoc. 2017;6(4):e005042. doi:10.1161/JAHA.116.005042
20. Hong C, Zhang Q, Chen Y, Lu Y, Chen L, He Y et al. Elevated uric acid mediates the effect of obesity on hypertension development: a causal mediation analysis in a prospective longitudinal study. Clin Epidemiol. 2022;14:463-73. doi:10.2147/CLEP.S363429
21. Wang J, Qin T, Chen J, Li Y, Wang L, Huang H et al. Hyperuricemia and risk of incident hypertension: a systematic review and meta-analysis of observational studies. PLoS One. 2014;9(12):e114259. doi:10.1371/journal.pone.0114259
22. Bjornstad P, Laffel L, Lynch J, El Ghormli L, Weinstock RS, Tollefsen SE et al.; TODAY Study Group. Elevated serum uric acid is associated with greater risk for hypertension and diabetic kidney diseases in obese adolescents with type 2 diabetes: an observational analysis from the treatment options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study Diabetes Care. 2019;42(6):1120-1128. doi:10.2337/dc18-2147
23. Qin T, Zhou X, Wang J, Wu X, Li Y, Wang L et al. Hyperuricemia and the prognosis of hypertensive patients: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2016;18(12):1268-1278. doi:10.1111/jch.12855
24. Fomin VV, Morosova TE, Tsurko VV. Hyperuricemia, gout and high cardiovascular risk — how to manage them in clinical practice. Ther Arch. 2019;91(12):75-83. doi:10.26442/00403660.2019.12.000173. In Russian.
25. Kunitskaya NA, Ariev AL, Nemirovsky VS. The role of uric acid in the development of cardiovascular diseases: from molecular mechanisms to clinical manifestations. Doctor. 2022;(6):5-12. doi:10.29296/25877305-2022-06-01. In Russian.
26. Skoczynska M, Chowaniec M, Szymczak A, Langner-Hetmanczuk A, Maciqzek-Chyra B, Wiland P Pathophysiology of hyperuricemia and its clinical significance — a narrative review. Reumatologia. 2020;58(5):312-323. doi:10.5114/reum.2020.100140
27. Shalnova SA, Deev AD, Artamonov GV, Duplyakov DV, Efanov AYu, Zhernakova YuV et al. Hyperuricemia and its correlates in the russian population (results of ESSE-RF epidemiological study). Rat Pharmacother Cardiol. 2014;10(2):153-159. doi:10.20996/1819-6446-2014-10-2-153-159. In Russian.
28. Eliseev MS, Novikova AM. Comorbidity in gout and hyperuricemia: prevalence, causes, prospects of urate lowering therapy. Ther Arch. 2019;91(5):120-128. doi:10.26442/00403660.2019.05.000232. In Russian.
29. Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford). 2019;58(12):2177-2180. doi:10.1093/rheumatology/kez196
30. Choi HK, McCormick N, Lu N, Rai SK, Yokose C, Zhang Y. Population impact attributable to modifiable risk factors for hyperuricemia. Arthritis Rheumatol. 2020;72(1):157-165. doi:10.1002/art.41067
31. Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P; EULAR Standing Committee for International Clinical Studies Including Therapeutics. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):131-1324. doi:10.1136/ard.2006.055269
32. Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 20072008. Am J Med. 2012;125(7):679-687.e1. doi:10.1016/j.amjmed.2011.09.033
33. Boocock J, Leask M, Okada Y, Matsuo H, Kawamura Y, Shi Y et al.; Asian Genetic Epidemiology Network (AGEN) Consortium. Genomic dissection of 43 serum urate-associated loci provides multiple insights into molecular mechanisms of urate control. Hum Mol Genet. 2020;29(6):923-943. doi:10.1093/hmg/ddaa013
34. Ben Salem C, Slim R, Fathallah N, Hmouda H. Drug-induced hyperuricaemia and gout. Rheumatology (Oxford). 2017;56(5):679-688. doi:10.1093/rheumatology/kew293
35. Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med. 2005;165(7):742-728. doi:10.1001/archinte.165.7.742
36. Hunter DJ, York M, Chaisson CE, Woods R, Niu J, Zhang Y. Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. J Rheumatol. 2006;33(7):1341-1345. Erratum in: J Rheumatol. 2006;33(8):1714.
37. McAdams DeMarco MA, Maynard JW, Baer AN, Gelber AC, Young JH, Alonso A et al. Diuretic use, increased serum urate levels, and risk of incident gout in a population-based study of adults with hypertension: the atherosclerosis risk in communities cohort study. Arthritis Rheum. 2012;64(1):121-129. doi:10.1002/art.33315
38. Bruderer S, Bodmer M, Jick SS, Meier CR. Use of diuretics and risk of incident gout: a population-based case-control study. Arthritis Rheumatol. 2014;66(1):185-196. doi:10.1002/art.38203. Erratum in: Arthritis Rheumatol. 2014;66(2):427.
39. Wilson L, Nair KV, Saseen JJ. Comparison of new-onset gout in adults prescribed chlorthalidone vs. hydrochlorothiazide for hypertension. J Clin Hypertens (Greenwich). 2014;16(12):864-868. doi:10.1111/jch.12413
40. Juraschek SP, Simpson LM, Davis BR, Shmerling RH, Beach JL, Ishak A et al. The effects of antihypertensive class on gout in older adults: secondary analysis of the antihypertensive and lipid-lowering treatment to prevent heart attack trial. J Hypertens. 2020;38(5):954-960. doi:10.1097/HJH.0000000000002359
41. Cabrera SE, Edwards NC, Steeds RP, Townend JN, Ferro CJ. Spironolactone increases serum uric acid levels in patients with chronic kidney disease. J Hum Hypertens. 2014;28(3):210-211. doi:10.1038/jhh.2013.66
42. Narang RK, Gamble G, Phipps-Green AJ, Topless R, Cadzow M, Stamp LK et al. Do serum urate-associated genetic variants influence gout risk in people taking diuretics? Analysis of the UK Biobank. J Rheumatol. 2020;47(11):1704-1711. doi:10.3899/jrheum.191005
43. Cunha TDS, Gomes SA, Heilberg IP. Thiazide and thiazide-like diuretics in nephrolithiasis. J Bras Nefrol. 2021;43(1):103-109. doi:10.1590/2175-8239-JBN-2019-0148
44. Petreski T, Ekart R, Hojs R, Bevc S. Hyperuricemia, the heart, and the kidneys — to treat or not to treat? Ren Fail. 2020;42(1):978-986. doi:10.1080/0886022X.2020.1822185
45. Eleftheriadis T, Golphinopoulos S, Pissas G, Stefanidis I. Asymptomatic hyperuricemia and chronic kidney disease: Narrative review of a treatment controversial. J Adv Res. 2017;8(5):555-560. doi:10.1016/j.jare.2017.05.001
46. Nieradko-Iwanicka B. What is the role of angiotensin receptor blockers in treatment of hyperuricemia coexisting with arterial hypertension? Reumatologia. 2018;56(2):106-110. doi:10.5114/reum.2018.75522
47. Kim HS, Kim H, Lee SH, Kim JH. Comparative analysis of the efficacy of angiotensin II receptor blockers for uric acid level change in asymptomatic hyperuricaemia. J Clin Pharm Ther. 2020;45(6):1264-1270. doi:10.1111/jcpt.13202
48. Selvaraj S, Claggett BL, Pfeffer MA, Desai AS, Mc Causland FR, McGrath MM et al. Serum uric acid, influence of sacubitril-valsartan, and cardiovascular outcomes in heart failure with preserved ejection fraction: PARAGON-HF. Eur J Heart Fail. 2020;22(11):2093-2101. doi:10.1002/ejhf.1984
49. Ogata N, Fujimori S, Oka Y, Kaneko K. Effects of three strong statins (atorvastatin, pitavastatin, and rosuvastatin) on serum uric acid levels in dyslipidemic patients. Nucleosides Nucleotides Nucleic Acids. 2010;29(4-6):321-324. doi:10.1080/15257771003741323
50. Zhang J, Ji X, Dong Z, Lu J, Zhao Y, Li R et al. Impact of fenofibrate therapy on serum uric acid concentrations: a review and meta-analysis. Endocr J. 2021;68(7):829-837. doi:10.1507/endocrj.EJ20-0808
51. Keller SF, Rai SK, Lu N, Oza A, Jorge AM, Zhang Y et al. Statin use and mortality in gout: a general population-based cohort study. Semin Arthritis Rheum. 2018;48(3):449-455. doi:10.1016/j.semarthrit.2018.03.007
52. Jorge AM, Lu N, Keller SF, Rai SK, Zhang Y, Choi HK. The effect of statin use on mortality in systemic autoimmune rheumatic diseases. J Rheumatol. 2018;45(12):1689-1695. doi:10.3899/jrheum.171389
53. Zhao Y, Xu L, Tian D, Xia P, Zheng H, Wang L et al. Effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on serum uric acid level: a meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2018;20(2):458-462. doi:10.1111/dom.13101
54. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-57. doi:10.1161/HYPERTENSIONAHA.120.15026
55. Agarwal V, Hans N, Messerli FH. Effect of allopurinol on blood pressure: a systematic review and meta-analysis. J Clin Hypertens. 2013;15(6):435-442. doi:10.1111/j.1751-7176.2012.00701.x
56. Borghi C, Agnoletti D, Cicero AFG, Lurbe E, Virdis A. Uric acid and hypertension: a review of evidence and future perspectives for the management of cardiovascular risk. Hypertension. 2022;79(9):1927-1936. doi:10.1161/HYPERTENSIONAHA.122.17956
57. Tien YY, Shih MC, Tien CP, Huang HK, Tu YK. To treat or not to treat? Effect of urate-lowering therapy on renal function, blood pressure and safety in patients with ssymptomatic hyperuricemia: a systematic review and network meta-analysis. J Am Board Fam Med. 2022;35(1):140-151. doi:10.3122/jabfm.2022.01.210273
58. Goicoechea M, Garcia de Vinuesa S, Verdalles U, Verde E, Macias N, Santos A et al. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Am J Kid Dis. 2015;65(4):543-549. doi:10.1053/j.ajkd.2014.11.016
59. Liu P, Chen Y, Wang B, Zhang F, Wang D, Wang Y. Allopurinol treatment improves renal function in patients with type 2 diabetes and asymptomatic hyperuricemia: 3-year randomized parallel-controlled study. Clin Endocrinol. 2015;83(4):475-482. doi:10.1111/cen.12673
60. Kimura K, Hosoya T, Uchida S, Inaba M, Makino H, Maruyama S et al. Febuxostat therapy for patients with stage 3 CKD and asymptomatic hyperuricemia: a randomized trial. Am J Kid Dis. 2018;72(6):798-810. doi:10.1053/j.ajkd.2018.06.028
61. Sapankaew T, Thadanipon K, Ruenroengbun N, Chaiyakittisopon K, Ingsathit A, Numthavaj P et al. Efficacy and safety of urate-lowering agents in asymptomatic hyperuricemia: systematic review and network meta-analysis of randomized controlled trials. BMC Nephrol. 2022;23(1):223. doi:10.1186/s12882-022-02850-3
62. Chazova IE, Zhernakova YuV, Kislyak OA, Nedogoda SV, Podzolkov VI, Oshchepkova EV et al. Consensus on the management of patients with hyperuricemia and high cardiovascular risk. Syst Hypertens. 2019;16(4):8-21. doi:10.26442/2075082X.2019.4.190686. In Russian.
63. Kobalava ZD, Troitskaya EA. Asymptomatic hyperuricemia: treatment approaches according to the risk of cardiovascular and renal events. Kardiologiia = Cardiology. 2020;60(12):104-109. doi:10.18087/cardio.2020.12.n1158. In Russian.
64. Hakoda M, Kasagi F. Increasing trend of asymptomatic hyperuricemia under treatment with urate-lowering drugs in Japan. Mod Rheumatol. 2019;29(5):880-884. doi:10.1080/14397595.2018.1519149
65. Zhang YF, He F, Ding HH, Dai W, Zhang Q, Luan H et al. Effect of uric-acid-lowering therapy on progression of chronic kidney disease: a meta-analysis. J Huazhong Univ Sci Technolog Med Sci. 2014;34(4):476-481. doi:10.1007/s11596-014-1302-4
66. Kuwabara M, Niwa K, Hisatome I, Nakagawa T, Roncal-Jimenez CA, Andres-Hernando A et al. Asymptomatic hyperuricemia without comorbidities predicts cardiometabolic diseases: Five-Year Japanese Cohort Study. Hypertension. 2017;69(6):1036-1044. doi:10.1161/HYPERTENSIONAHA.116.08998
67. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041. doi:10.1097/HJH.0000000000001940
68. Borghi C, Tykarski A, Widecka K, Filipiak KJ, DomienikKarlowicz J, Kostka-Jeziorny K et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiology Journal. 2018;25(5):545-563. doi:10.5603/CJ.2018.0116
69. [Электронный источник]. URL: https://yandex.ru/health/turbo/articles?id=7735
70. [Электронный источник]. URL: https://www.invitro.ru/library/labdiagnostika/27184
71. Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 20072008. Am J Med. 2012;125(7):679-687.e1. doi:10.1016/j.amjmed.2011.09.033
72. Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X
73. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455. Erratum in: Eur Heart J. 2020;41(44):4255.
74. Richette P, Poitou C, Manivet P, Denis J, Bouillot JL, Clement K et al. Weight loss, xanthine oxidase, and serum urate levels: A Prospective Longitudinal Study of obese patients. Arthritis Care Res (Hoboken). 2016;68(7):1036-1042. doi:10.1002/acr.22798
75. Chen JH, Wen CP, Wu SB, Lan JL, Tsai MK, Tai YP et al. Attenuating the mortality risk of high serum uric acid: the role of physical activity underused. Ann Rheum Dis. 2015;74(11):2034-2042. doi:10.1136/annrheumdis-2014-205312
76. Matsumura K, Arima H, Tominaga M, Ohtsubo T, Sasaguri T, Fujii K et al. Effect of losartan on serum uric acid in hypertension treated with a diuretic: the COMFORT study. Clin Exp Hypertens. 2015;37(3):192-196. doi:10.3109/10641963.2014.933968
77. Jacob RA, Spinozzi GM, Simon VA, Kelley DS, Prior RL, Hess-Pierce B et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr. 2003;133(6):1826-1829. doi:10.1093/jn/133.6.1826
78. Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. 2005;11(32):4133-4138. doi:10.2174/138161205774913273
79. Borghi C, Agnoletti D, Cicero AFG, Lurbe E, Virdis A. Uric acid and hypertension: a review of evidence and future perspectives for the management of cardiovascular risk. Hypertension. 2022: 101161HYPERTENSIONAHA12217956. doi:10.1161/HYPERTENSIONAHA.122.17956
Supplementary files
Review
For citations:
Koziolova N.A., Chernyavina A.I. Hypertension and asymptomatic hyperuricemia: algorithm of diagnostics and management (literature review). "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2022;28(4):316-327. (In Russ.) https://doi.org/10.18705/1607-419X-2022-28-4-316-327
Views:
1628
Email this article 