AbstractObjective: It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients.Design and method: In the LIFE study, a double masked, parallel-group design, 9193 patients with hypertension and electrocardiographic (ECG) LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD.Results: NOD developed in 522 of 7489 patients. The association between baseline SUA and development of NOD was significant (HR 1.29 per SD [1.3 mg/dl], 95% CI 1.18-1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow-Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18-1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per SD [1.3 mg/dl], 95% CI 1.02-1.19, P = 0.015).Conclusion: Our analysis suggests that serum uric acid is an independent risk marker for new-onset diabetes in hypertensive patients with left ventricular hypertrophy.