Evolutionary Insights Suggest Novel Treatments for Gout

Texas nephrologist Dr. Richard J. Johnson, who developed this hypothesis, said, “The uricase mutation may have provided an evolutionary advantage to early hominoids by maintaining blood pressure under the low sodium dietary conditions of that period” (Hypertension 2003;41:1183–90).

An association of gout with elevated blood pressure has long been noted, but these new findings suggest a causative role for hyperuricemia in hypertension, Dr. Pillinger said. One study of five adolescents with essential hypertension found that aggressive treatment with allopurinol normalized their blood pressure. Whether a causal link with uric acid can be found in all patients with hypertension remains to be seen but is intriguing, he said. A blinded trial investigating this question is currently underway.

Uric acid crystals in the urine of a patient with gout. After decades of inactivity, treatment advances are on the horizon. ©Bostwick Laboratories