There is consensus on starting urate-lowering therapy (ULT) in cases of symptomatic hyperuricemia, but the frequent condition of asymptomatic hyperuricemia (AH), remains a challenge, given the different findings of studies on the relationship between serum acid uric levels and comorbidities. Here we systematically assess randomized controlled trials (RCTs) evaluating ULT in patients with AH. We also discuss the safety profile of ULT and provide an overview of recent recommendations from current guidelines.