Serum uric acid levels and cardiorenal complication prevalence in hypertensive patients before and after the COVID-19 pandemic: a retrospective cross-sectional study from a tertiary traditional Chinese medicine hospital.
Yuan J, Hua P, et al. • Frontiers in endocrinology • 2026
In hypertensive patients, the post-pandemic period was associated with higher serum uric acid levels and greater cardiorenal complication prevalence, with hyperuricemia and the post-pandemic period showing a significant multiplicative interaction on cardiorenal risk.
Key Findings
Results
Post-pandemic hypertensive patients had significantly higher mean serum uric acid (SUA) levels compared to pre-pandemic patients.
Mean SUA was 448.70 ± 72.04 µmol/L in the post-pandemic group versus 422.39 ± 71.92 µmol/L in the pre-pandemic group (P < 0.001).
The study included 3,036 hypertensive adults: pre-pandemic n = 1,482 (January 2017–December 2019) and post-pandemic n = 1,554 (January 2023–March 2025).
The study was conducted at Pu'er City Hospital of Traditional Chinese Medicine as a retrospective cross-sectional design.
Hyperuricemia was defined as SUA > 420 µmol/L for both men and women per 2019 Chinese guidelines.
Results
The prevalence of hyperuricemia was significantly higher in the post-pandemic period than in the pre-pandemic period.
Hyperuricemia prevalence was 65.9% in the post-pandemic group versus 52.1% in the pre-pandemic group (P < 0.001).
This represents an absolute difference of approximately 13.8 percentage points between periods.
Both periods used the same definition of hyperuricemia (SUA > 420 µmol/L) to ensure comparability.
Results
The overall prevalence of any cardiorenal complication was substantially higher in the post-pandemic group compared to the pre-pandemic group.
Cardiorenal complication prevalence was 74.1% in the post-pandemic group versus 49.1% in the pre-pandemic group (P < 0.001).
The primary outcome was defined as any cardiorenal complication, including chronic kidney disease, heart failure, stroke, or atrial fibrillation.
The absolute difference in complication prevalence between periods was approximately 25 percentage points.
Results
Hyperuricemia was independently associated with any cardiorenal complication in fully adjusted logistic regression models.
The adjusted OR for hyperuricemia and any cardiorenal complication was 1.82 (95% CI: 1.39–2.39; P < 0.001).
The post-pandemic period was also independently associated with cardiorenal complications (OR = 1.94, 95% CI: 1.50–2.50; P < 0.001).
Both associations were identified in fully adjusted multiplicative interaction models.
Findings were consistent across age and sex subgroups and across all six pre-specified sensitivity analyses.
Results
A statistically significant multiplicative interaction was observed between study period and hyperuricemia on cardiorenal complication risk.
The interaction OR on the multiplicative scale was 1.79 (95% CI: 1.27–2.53; P = 0.001).
This indicates that the combined effect of hyperuricemia and the post-pandemic period on cardiorenal risk exceeded what would be expected from their independent multiplicative effects alone.
Interaction was assessed on both multiplicative and additive scales as pre-specified analyses.
Results
Additive interaction measures were directionally consistent with positive synergism between hyperuricemia and the post-pandemic period, but were not statistically conclusive.
Additive interaction metrics were: RERI = 0.155, attributable proportion (AP) = 0.070, and synergy index (S) = 1.149.
Bootstrap confidence intervals for all three additive interaction measures included the null, indicating statistical inconclusion.
The authors described these findings as 'directionally consistent with positive synergism' but not statistically significant on the additive scale.
The additive scale results contrast with the statistically significant multiplicative interaction (P = 0.001).
What This Means
This research suggests that hypertensive patients treated at a traditional Chinese medicine hospital in China after the COVID-19 pandemic had notably higher levels of uric acid in their blood and a much higher rate of heart and kidney complications compared to patients seen before the pandemic. Specifically, about 66% of post-pandemic patients had hyperuricemia (abnormally high uric acid) compared to 52% before the pandemic, and nearly three-quarters of post-pandemic patients had at least one cardiorenal complication such as chronic kidney disease, heart failure, stroke, or atrial fibrillation, compared to about half of pre-pandemic patients.
The study also found that having high uric acid and being treated in the post-pandemic period each independently increased the odds of having cardiorenal complications, and importantly, these two factors appeared to work together more than would be expected by chance alone — at least when measured on a multiplicative statistical scale. This means the combination of high uric acid levels and the post-pandemic context may carry a greater-than-additive risk for complications in hypertensive patients. However, when tested using a different statistical approach (additive interaction), the evidence for this synergistic effect was suggestive but not statistically definitive.
This research suggests that the COVID-19 pandemic period may have contributed to worsening metabolic conditions, including elevated uric acid, among people with high blood pressure, and that monitoring and managing uric acid levels may be particularly important in post-pandemic care for hypertensive patients. Because this was a retrospective study from a single hospital, the findings may not apply broadly to all populations, and the cross-sectional design means causation cannot be established.
Yuan J, Hua P, He X, Huo Z, Li Y, Yang X, et al.. (2026). Serum uric acid levels and cardiorenal complication prevalence in hypertensive patients before and after the COVID-19 pandemic: a retrospective cross-sectional study from a tertiary traditional Chinese medicine hospital.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1830233