Bidirectional Association between Self-Reported Hypertension and Gout: The Singapore Chinese Health Study.
It has been hypothesized that the association between hypertension and gout is bidirectional, however, few studies have examined this in a prospective cohort. We analyzed data from the Singapore Chinese Health Study (SCHS) follow-up I (1999-2004) and II (2006-2010) interviews, when both physician-diagnosed hypertension and gout were self-reported. We included participants with data for both follow-up interviews and who were free of heart disease, stroke and cancer at follow-up I. The analysis of hypertension and risk of gout included 31,137 participants when prevalent gout cases were excluded, while the analysis of gout and risk of hypertension included 20,369 participants when prevalent hypertension cases were excluded. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The mean age at follow-up I was 60.1 (SD 7.3) years, and the average follow-up was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 682 incident cases were identified. Compared to normotensive participants, hypertensive patients had an 88% increased risk of developing gout (HR 1.88; 95% CI 1.61-2.21). In the parallel analysis, 5,450 participants reported to have newly diagnosed hypertension during follow-up. Compared to participants without gout, those with gout had an 18% increased risk of developing hypertension (HR 1.18; 95% CI 1.02-1.37). The bidirectional association was stronger in normal weight adults compared to overweight/obese individuals (Pinteraction = 0.06 and 0.04, respectively). The hypertension to gout association was stronger in women compared to men (Pinteraction = 0.04), while the gout to hypertension association was evident in women but not in men (Pinteraction = 0.02). In conclusion, our results suggest that the hypertension-gout association is bidirectional in this cohort of Singapore Chinese adults. The potential interactions of the bidirectional association with obesity and sex deserve further investigations.
Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
An
A
Pan
Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore; University Medicine Cluster, Division of Rheumatology, National University Hospital and National University Health System, Singapore, Republic of Singapore.
Gim Gee
GG
Teng
Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America.
Jian-Min
JM
Yuan
Duke-NUS Graduate Medical School Singapore, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Woon-Puay
WP
Koh
D000368:Aged; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D006073:Gout / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D057566:Self Report; D012846:Singapore / Q000453:epidemiology / Q000208:ethnology