Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study

Abstract

Objective To determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension.Design Nested case-control study.Setting UK general practice database, 2000-7.Participants All incident cases of gout (n=24 768) among adults aged 20-79 and a random sample of 50 000 matched controls.Main outcome measure Relative risk of incident gout associated with use of antihypertensive drugs.Results After adjusting for age, sex, body mass index, visits to the general practitioner, alcohol intake, and pertinent drugs and comorbidities, the multivariate relative risks of incident gout associated with current use of antihypertensive drugs among those with hypertension (n=29 138) were 0.87 (95% confidence interval 0.82 to 0.93) for calcium channel blockers, 0.81 (0.70 to 0.94) for losartan, 2.36 (2.21 to 2.52) for diuretics, 1.48 (1.40 to 1.57) for β blockers, 1.24 (1.17 to 1.32) for angiotensin converting enzyme inhibitors, and 1.29 (1.16 to 1.43) for non-losartan angiotensin II receptor blockers. Similar results were obtained among those without hypertension. The multivariate relative risks for the duration of use of calcium channel blockers among those with hypertension were 1.02 for less than one year, 0.88 for 1-1.9 years, and 0.75 for two or more years and for use of losartan they were 0.98, 0.87, and 0.71, respectively (both P<0.05 for trend).Conclusions Compatible with their urate lowering properties, calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension. By contrast, diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout.

Effects on Uric Acid Metabolism of the Drugs except the Antihyperuricemics

“…According to a large casecontrol study exploring the effect of antihypertensive drugs on the risk of incident gout attacks, calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension. By contrast, diuretics, b blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout [60].…”

Update on hyperuricaemia and gout with evidence based management guidelines

“…4 Calcium channel blockers, amlodipine and nifedipine, were also associated with a reduction in the serum uric acid and a 21% and 13% reduced risk of gout. 23 Fenofibrates, which are effective in the management of hyperlipidaemia, also have a uricosuric effect and lower the serum uric acid. 24 They have also been shown to enhance the effect of allopurinol in patients with HU and gout.…”

“…23,44 Thus it is recommended for the control of hypertension in patients with asymptomatic HU and gout. 4 Calcium channel blockers, amlodipine and nifedipine, were also associated with a reduction in the serum uric acid and a 21% and 13% reduced risk of gout.…”

Gout – a guide for the general and acute physicians

“…24 Hyperlipidaemia should be treated with atorvastatin or fenofibrate. 24 The cardiovascular benefit from low-dose aspirin outweighs the insignificant risk of hyperuricaemia from reduced renal urate excretion, and it should be continued if indicated.…”

“…24 Hyperlipidaemia should be treated with atorvastatin or fenofibrate. 24 The cardiovascular benefit from low-dose aspirin outweighs the insignificant risk of hyperuricaemia from reduced renal urate excretion, and it should be continued if indicated. 15 Similarly, diuretics prescribed for heart failure should be continued but bendroflumethiazide prescribed for hypertension should be changed to an alternative antihypertensive.…”