title: Effect of allopurinol on blood pressure and aortic compliance in hypertensive patients.
abstract: BACKGROUND
  Arterial hypertension is commonly associated with hyperuricemia. Several studies have shown that allopurinol reduces arterial blood pressure in animal models and in adolescent patients with newly diagnosed hypertension. Moreover, allopurinol has shown beneficial effects on endothelial function and arterial wave reflection in contrast to uricosuric agents. Antihypertensive drugs produce different effects on serum uric acid levels.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the influence of allopurinol on blood pressure and aortic compliance in patients with arterial hypertension depending on hypotensive therapy with angiotensin-converting enzyme inhibitor (ACE-I) or thiazide diuretic, hypotensive drugs with distinct effects on serum uric acid levels and conversely, a positive influence on pulse wave velocity (PWV) in the aorta.
  
  
  METHODS
  Sixty-six patients aged 25-70 (mean age 46.17 ± 10.89) with mild and moderate arterial hypertension diagnosed on the basis of office blood pressure, were studied. They were randomized to antihypertensive therapy on either perindopril (n = 35) or hydrochlorothiazide (n = 31). After 8 weeks of antihypertensive therapy, 150 mg of allopurinol daily was added for the next 8 weeks. Measurement of the serum uric acid level, PWV and 24-h ambulatory blood pressure monitoring (ABPM) were performed at baseline, after 8 weeks antihypertensive therapy and again after the final 8 weeks with the additional allopurinol.
  
  
  RESULTS
  No significant changes in systolic (SBP) and diastolic blood pressure (DBP) or ABPM were observed after allopurinol treatment in either of the subgroups receiving ACE-I or thiazide-based antihypertensive therapy. The mean PWV decreased from 10.7 ± 1.4 m/s to 10.0 ± 1.2 m/s (p = 0.00008) in the ACE-I-based therapy subgroup and from 11.5 ± 1.7 m/s to 10.4 ± 1.5 m/s (p = 0.00002) in the thiazide-based therapy subgroup after treatment with allopurinol. However, significant correlations were found between PWV changes and the basic PWV (r = -0.52; p < 0.001) or SBP changes (r = 0.29; p < 0.019) after allopurinol treatment.
  
  
  CONCLUSIONS
  Allopurinol does not produce additional antihypertensive effects in patients with treated arterial hypertension. Allopurinol increases aortic compliance independently of ACE-I or thiazide-based, antihypertensive therapy. However, this effect is significantly dependent on the initial PWV in the aorta and on SBP changes during allopurinol therapy.
authors.affiliation: Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kostka-Jeziorny
authors.forename: Paweł
authors.initials: P
authors.lastname: Uruski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tykarski
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001011:Aorta / Q000187:drug effects / Q000473:pathology; D001794:Blood Pressure / Q000187:drug effects; D003187:Compliance / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D014528:Uricosuric Agents; D006852:Hydrochlorothiazide; D014527:Uric Acid; D000493:Allopurinol; D020913:Perindopril