To examine the associations between serum uric acid and all-cause, cardiovascular, and cancer mortality among hypertensive adults using diuretics.

We included hypertensive adults who reported diuretic use across 10 cycles (1999—2018) of the National Health and Nutrition Examination Survey (NHANES). Weighted Kaplan-Meier curves,Cox proportional hazards regression models, and restricted cubic splines were applied to examine the associations between serum uric acid levels and all-cause, cardiovascular, and cancer mortality. Subgroup analyses were conducted.

Among 3 744 hypertensive adults treated with diuretics, we prospectively observed a mean follow up of 7.9 years and recorded 1 428 deaths from all causes, including 563 cardiovascular deaths and 248 cancer deaths. Weighted Kaplan-Meier analyses indicated a significantly higher cumulative incidence of all cause, cardiovascular, and cancer mortality in the hyperuricemia group versus the non-hyperuricemia group (P<0.05). After adjustment for covariates, elevated serum uric acid levels were associated with increased risks of all-cause and cardiovascular mortality, with hazard ratios (HRs) of 1.05 (95% CI: 1.01-1.09) and 1.10 (95% CI: 1.02-1.18), respectively. Weighted restricted cubic splines revealed linear dose-response relationships between serum uric acid levels and both all-cause and cardiovascular mortality (P for nonlinear >0.05). Subgroup analyses were consistent and showed no interactions (P>0.05). Uric acid levels were not significantly associated with cancer mortality.

Among hypertensive diuretic users, serum uric acid is linearly and positively associated with risks of all-cause and cardiovascular mortality.