Evidence is accumulating that hyperuricemia is closely associated with lifestyle-related diseases including hypertension and may play a significant role as cardiovascular risk. Hypertensive patients especially complicated with obesity or metabolic syndrome are more likely to be resistant hypertension. In the management of resistant hypertension, antihypertensive combination therapy including diuretics is often necessary to achieve strict blood pressure control advocated by the hypertension guidelines. However, hyperuricemia is commonly associated with hypertension with metabolic syndrome or chronic kidney disease and the use of diuretics may further increase serum uric acid. Thus, careful management of uric acid with the appropriate use of uric acid-lowering drugs is warranted when diuretics are included in the treatment of hypertension. The goal of serum uric acid level in the uric acid-lowering therapy in hypertensive patients with hyperuricemia awaits the future intervention trials.