Consensus on the treatment of hyperuricemia in individuals at high cardiovascular risk – update 2025: brief summary

Overview

Hyperuricemia (HU) is a common condition with an increasing prevalence, particularly among individuals with hypertension, chronic kidney disease (CKD), obesity, diabetes, or cardiovascular (CV) disease. Traditionally, it has been viewed primarily as a cause of gout; however, there is growing evidence of an independent association between elevated serum uric acid (sUA) levels and mortality from CV causes, heart failure, stroke, and accelerated progression of CKD. According to epidemiological studies, this association may manifest even at sUA levels significantly below the classical threshold for crystal formation, particularly in patients with high CV risk. However, randomized trials have not yet unequivocally demonstrated either cardiovascular or renal benefits of routine sUA-lowering therapy in patients with asymptomatic HU. In 2025, a multidisciplinary panel of European experts in cardiology, internal medicine, nephrology, and hypertension treatment prepared an updated consensus in which they propose an individualized approach to HU management based on risk stratification for each specific patient. It is supported by current evidence from a review of the published literature, including large cohort studies, meta-analyses, randomized controlled trials, and current European guidelines (ESC, ESH, KDIGO, EULAR). It emphasizes sUA cut-off values determined based on clinical outcomes and practically applicable risk stratification, and presents a pragmatic “six-level therapeutic algorithm” encompassing lifestyle intervention, optimization of comorbidities and pharmacological treatment to lower serum uric acid levels, if indicated.

Keywords:

stroke – hypertension – cardiovascular disease – chronic kidney disease – hyperuricemia – consensus