Many studies have demonstrated that elevated serum
uric acid independently increases the risk of developing
hypertension. However, the role of
insulin resistance in the relationship between serum
uric acid and
hypertension is still unelucidated. Based on a prospective cohort study, we aimed to examine the longitudinal link between serum
uric acid and
hypertension and whether this relationship was mediated by
insulin resistance. Overall, 21,999 participants without
hypertension or
gout at baseline with a mean age of 46 ± 13 years in the Jinchang Cohort were included in our study. Adjusted Cox-regression analyses and mediation analyses were performed to assess the risk of
hypertension by serum
uric acid quartile distribution and whether
insulin resistance mediated the association between serum
uric acid and
hypertension. During the first follow-up period, 3080 participants developed
hypertension. After controlling for covariates, compared with the lowest quartile of serum
uric acid, the risk of
hypertension in the highest quartile was 1.21 (1.06, 1.38) in the overall population. The risks for males and females were 1.14 (1.00-1.29) and 1.30 (1.08-1.56), respectively. The correlation between serum
uric acid and
hypertension was especially observed in younger people (<30 years). The mediating effects of
insulin resistance were 0.058 (0.051, 0.065), 0.030 (0.025, 0.036) and 0.056 (0.047, 0.065), and the proportions mediated were 39.73, 36.59 and 38.62% in the overall, male and female populations, respectively. Elevated serum
uric acid levels are associated with an increased risk of incident
hypertension, and
insulin resistance may play a mediating role in the relationship between serum
uric acid and
hypertension.