Background: Development of target organ damages like chronic kidney disease and coronary artery disease in hypertension is more common and more rapid. Identifying sub clinical target organ damage in prehypertensive phase is essential to prevent complications. Objective: Prehypertension is an elevation of systolic blood pressure of 120 - 139 mmHg and diastolic blood pressure of 80 __ampersandsignndash; 89mmHg. The purpose of this case __ampersandsignndash; control study was to corelate serum uric acid levels in Prehypertensive patients to the presence or absence of microalbuminuria. Method: This study was done at the Department of Internal Medicine, DR. PSIMS and RF foundation, Chinaoutpally, A.P.India between Jan 2011 to Dec 2012. 1000 patients (500 cases, 500 controls) above 18 years of age were included in the study. The microalbuminuric reference range was 30 __ampersandsignndash; 300mg/day. The reference values for serum Uric acid levels in males: 3.4 __ampersandsignndash; 7.0mg/dl and females were 2.4 __ampersandsignndash; 5.4mg/dl. Results: In our study, the microalbuminuria was present in 17.4% of prehypertensive cases and 3.4% of controls (p=0.0001), with mean value of microalbuminuria in cases was 30.91 + 16.54 and in controls was 7.191 + 6.039 (p = 0.0001). The mean serum uric acid levels in Prehypertensive group was 5.107 + 2.286 and in controls was 2.614 + 1.58 (p __ampersandsignlt;0.05), The mean serum uric acid levels in Prehypertensive group with microalbuminuria was 7.187 + 1.65 and in normoalbuminuria was 4.669 2 + 2.157 (p__ampersandsignlt;0.05). Conclusions: Serum uric acid levels were found to be significantly higher in Prehypertensive patients with microalbuminuria than without microalbuminuria.