Prevention of Hyperuricemia by Allopurinol in Hypertensive Patients Treated with Chlorothiazide

Nicotero, James A.; Scheib, Eileen T.; Martinez, Ramon; Rodnan, Gerald P.; Shapiro, Alvin P.

doi:10.1056/nejm197001152820305

Cited by 14 publications

(2 citation statements)

References 18 publications

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“…Diuretic-induced hyperuricemia can be readily controlled with hypouricemic agents when indicated (22,23) without apparently altering the natruretic effect of the diuretic agent. Beyer & Baer noted that the secretion of chlorothiazides by renal tissue from mongrel dogs was inhibited by probenecid (24,25).…”

Section: Diureticsmentioning

confidence: 99%

Effects of Drugs on Uric Acid in Man

Kelley¹

1975

Annu. Rev. Pharmacol.

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In this review the drugs capable of increasing or lowering the serum urate concentration are considered with regard to mechanism of action and significance of the effect, where known. Several hypouricemic agents, probenecid, sulfinpyrazone, and allopurinol, are considered in further detail because of their major clinical importance. No effort has been made, however, to summarize the relative clinical indications for each agent. In addition, in those cases where specific details could not be included because of limitation of space, the appropiate reference has been given.

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Section: Diureticsmentioning

confidence: 99%

Effects of Drugs on Uric Acid in Man

Kelley¹

1975

Annu. Rev. Pharmacol.

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“…The two publications report identical data on cardiovascular events, which were included once in our meta-analysis. Two randomized crossover trials were included [ 45 , 46 ]. In the included trials, a total of 3080 patients have been allocated to either allopurinol (n = 1638) or no-urate-lowering therapy (n = 1442).…”

Section: Resultsmentioning

confidence: 99%

Allopurinol to reduce cardiovascular morbidity and mortality: A systematic review and meta-analysis

et al. 2021

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Aims To compare the effectiveness of allopurinol with no treatment or placebo for the prevention of cardiovascular events in hyperuricemic patients. Methods and results Pubmed, Web of Science and Cochrane library were searched from inception until July 2020. Randomized controlled trials (RCT) and observational studies in hyperuricemic patients without significant renal disease and treated with allopurinol, versus placebo or no treatment were included. Outcome measures were cardiovascular mortality, myocardial infarction, stroke, or a combined endpoint (CM/MI/S). For RCT’s a random effects meta-analysis was performed. For observational studies a narrative synthesis was performed. Of the original 1995 references we ultimately included 26 RCT’s and 21 observational studies. We found a significantly reduced risk of combined endpoint (Risk Ratio 0.65 [95% CI] [0.46 to 0.91]; p = 0.012) and myocardial infarction (RR 0.47 [0.27 to 0.80]; p = 0.01) in the allopurinol group compared to controls. We found no significant effect of allopurinol on stroke or cardiovascular mortality. Of the 15 observational studies with sufficient quality, allopurinol was associated with reduced cardiovascular mortality in 1 out of 3 studies that reported this outcome, myocardial infarction in 6 out of 8, stroke in 4 out of 7, and combined end-point in 2 out of 2. Cardiovascular benefit was only observed when allopurinol therapy was prolonged for more than 6 months and when an appropriate allopurinol dose was administered (300 mg or more/day) or sufficient reduction of serum urate concentration was achieved (<0.36 mmol/l). Conclusions Data from RCT’s and observational studies indicate that allopurinol treatment reduces cardiovascular risk in patients with hyperuricemia. However, the quality of evidence from RCTs is low to moderate. To establish whether allopurinol lowers the risk of cardiovascular events a well-designed and adequately powered randomized, placebo-controlled trial is needed in high-risk patients with hyperuricemia. Systematic review registration PROSPERO registration CRD42018089744

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Severe allopurinol hypersensitivity. Association with thiazides and prior renal compromise

Young¹

1974

Archives of Internal Medicine

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Prevention of Hyperuricemia by Allopurinol in Hypertensive Patients Treated with Chlorothiazide

Cited by 14 publications

References 18 publications

Effects of Drugs on Uric Acid in Man

Effects of Drugs on Uric Acid in Man

Allopurinol to reduce cardiovascular morbidity and mortality: A systematic review and meta-analysis

Severe allopurinol hypersensitivity. Association with thiazides and prior renal compromise

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