Blood Pressure, 2015; 24: 198

REPLY TO THE LETTER Dear Editor, We would like to thank Yilmaz et al. for their interest and constructive comments on our article titled “The relationship between uric acid and erectile dysfunction in hypertensive subjects” (1). It is known that hyperuricemia leads to endothelial dysfunction through the generation of reactive oxygen species (2). Uric acid stimulates vascular smooth muscle cell proliferation, angiotensin II production and oxidative stress via the vascular renin– angiotensin system (3). Furthermore, it has been shown that lowering UA is beneficial in improving endothelial function (4). On the other hand, time is needed to develop these deleterious effects of hyperuricemia on endothelial functions. It is well known that there is a relationship between the hyperuricemia and hypertension (5,6). In addition to hypertension itself, antihypertensive drugs such as thiazide-like diuretics cause increased serum UA levels (7,8). Therefore, current hypertensive subjects may be further exposed to the deleterious effects of prolonged hyperuricemia than newly diagnosed hypertensives. We also considered performing the study in patients with recently diagnosed hypertension without using medical therapy, as Yilmaz et al. suggested. However, we thought that hyperuricemia-related endothelial dysfunction may be more pronounced in current hypertensives than newly diagnosed and drug-naive hypertensives, due to long-term exposure to high UA levels. Therefore, we studied patients using antihypertensive medication for at least 1 year. On the other hand, we accept that the present study result should be also tested in recently diagnosed hypertensive subjects without using medical therapy. Because of the significant relationship between hyperuricemia and arterial stiffness, the hazardous effects of hyperuricemia on endothelial function should be

investigated in different population with future largescale studies. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References 1. Aribas A, Kayrak M, Ulucan S, Keser A, Demir K, Alibasic H, et al. The relationship between uric acid and erectile dysfunction in hypertensive subjects. Blood Press. 2014;23:370–376. 2. Puddu P, Puddu GM, Cravero E, Vizioli L, Muscari A. Relationships among hyperuricemia, endothelial dysfunction and cardiovascular disease: Molecular mechanisms and clinical implications. J Cardiol. 2012;59:235–242. 3. Corry DB, Eslami P, Yamamoto K, Nyby MD, Makino H, Tuck ML. Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular rennin– angiotensin system. J Hypertens. 2008;26:269–275. 4. Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart 2013;99:759–766. 5. Gaffo AL, Jacobs DR, Sijtsma F, Lewis CE, Mikuls TR, Saag KG. Serum urate association with hypertension in young adults: Analysis from the Coronary Artery Risk Development in Young Adults cohort. Ann Rheum Dis. 2013;72:1321–1327. 6. Johnson RJ, Feig DI, Herrera-Acosta J, Kang DH. Resurrection of uric acid as a causal risk factor in essential hypertension. Hypertension. 2005;45:18–20. 7. Kahn AM. Effect of diuretics on the renal handling of urate. Semin Nephrol. 1988;8:305–314. 8. Weinman EJ, Eknoyan G, Suki WN. The influence of the extracellular fluid volume on the tubular reabsorption of uric acid. J Clin Invest. 1975;55:283–291. Alpay Aribas, Mehmet Kayrak & Hakan Akilli Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey

Correspondence: Alpay Aribas, Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey. Tel: 90 505 627 32 67. Fax: 90 332 223 61 81. E-mail: [email protected] This is a reply to the letter – Uric acid may cause of erectile dysfunction in hypertensive patients (DOI: 10.3109/08037051.2015.1023056) by Samet Yilmaz. Also published in the journal Blood Pressure. (Received 8 January 2015 ; accepted 30 January 2015) ISSN 0803-7051 print/ISSN 1651-1999 online © 2015 Scandinavian Foundation for Cardiovascular Research DOI: 10.3109/08037051.2015.1023979

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