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European consensus on hyperuricemia: Uric acid less than 360 µmol/L
European consensus on hyperuricemia: uric acid less than 360 µmol/L, and allopurinol is the first-line drug for lowering uric acid! European consensus on hyperuricemia.
In recent years, more and more people have high uric acid. People with high uric acid have an increased risk of coronary heart disease, hypertension, metabolic syndrome, atrial fibrillation, and fatty liver.
Recently, Europe released an expert consensus on the diagnosis and treatment of hyperuricemia in patients with high cardiovascular risk. 【Full text download】
The consensus pointed out that for people with high uric acid, the reasons for high uric acid should be found, such as diet, medication, comorbidities and risk factors, and targeted adjustment of diet and weight loss.
Effective management of hypertension, diabetes, metabolic syndrome, chronic kidney disease, and cardiovascular diseases should be carried out.
Among them, the management of hyperuricemia mainly includes five steps:
1. Assess blood uric acid level
Consensus recommends that if you have heart disease or high blood pressure, you should check blood uric acid. Uric acid should be <360 µmol/L.
However, it is agreed that for patients with high cardiovascular risk with at least two items such as hypertension, diabetes, dyslipidemia, target organ damage, or cardiovascular disease history, blood uric acid levels <300 µmol/L should be considered. However, this recommendation still lacks randomized controlled trials Confirmed.
2. Stop drugs that affect uric acid
Effective management of hypertension, diabetes, metabolic syndrome, chronic kidney disease and cardiovascular diseases.
If possible, replace hydrochlorothiazide.
The ARB drug Losartan has the effect of lowering uric acid, but it is not recommended to switch to Losartan;
For primary prevention of cardiovascular disease, consider stopping aspirin or switching to other drugs as appropriate;
For secondary prevention (already suffering from cardiovascular disease), it is not recommended to stop aspirin;
It is not recommended to switch to fenofibrate;
3. Improve lifestyle
- Eat less red meat and seafood with high purine content.
- Drink less sweet drinks.
- Restrict alcohol consumption;
- Weight loss and regular physical activity;
- Appropriate amount of coffee, dairy products, cherries, and vitamin C supplement.
4. Allopurinol is the first-line medication for lowering uric acid
For mild cases, 100-200 mg of allopurinol is recommended daily; for moderate cases, 300-600 mg of allopurinol daily; for severe cases, 700-900 mg of allopurinol daily.
The dose should be gradually increased to make uric acid reach the standard.
In patients with severe chronic kidney disease, allopurinol should be less than 100 mg per day or 100 mg per day but one day apart.
For dialysis patients, 300-400 mg of allopurinol should be given immediately after dialysis, and no additional doses should be given at other times.
Febuxostat has a slightly higher incidence of cardiovascular events, and it is not recommended for use in patients with high cardiovascular risk.
5. After the uric acid reaches the standard, do not stop the treatment, check the uric acid twice a year; in special circumstances, consider combining medication.
After using allopurinol, if uric acid is not up to standard, for patients with normal renal function, the dose of allopurinol can be increased to 900 mg/day, or benzbromarone, or benzbromarone and allopurinol can be combined.
To avoid allergies and hypersensitivity syndromes, allopurinol should be cautiously increased.
In addition, you can also consider the combination of resinad (200 mg per day) and allopurinol. Resinad can increase the efficacy of allopurinol and help reduce the dosage of allopurinol.
The consensus also pointed out that more evidence is needed for the treatment of asymptomatic hyperuricemia.
(source:internet, reference only)