Drugs that Make Gout Risk Go Up and Down

Gout risk affected by hypertension medications

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) In order to get your blood pressure under control, your doctor may give you some type of prescription drug. Your risk of developing gout may influence which drug you are prescribed.

Patients with high blood pressure (hypertension) may have an increased risk of gout if they are taking hypertension drugs such as water pills (diuretics), beta blockers, ACE inhibitors, or certain angiotensin II receptor blockers. In contrast, hypertension patients taking calcium channel blockers or losartan (sold as Cozaar) may have a lower risk of gout.

"Work with your doctor to find the best hypertension drug for you."

In a recent study, Hyon K. Choi, M.D., of Boston University School of Medicine, and colleagues looked at the relationship between blood pressure drugs and the risk of gout.

They found that while a couple types of medications may lower the risk of gout among people with high blood pressure, many hypertension drugs may increase the risk of gout.

Gout is a type of arthritis that develops when too much uric acid builds up in the blood, leading to painful inflammation of the joints.

Dr. Choi and colleagues write that the reduced risk of gout associated with calcium channel blockers is possibly the result of these drugs' effects on kidney function. Calcium channel blockers - such as Norvasc (amlodipine), Cardizem LA (diltiazem), Procardia (nifedipine), and others - have been shown to increase the amount of uric acid processed through the kidneys and excreted out of the body.

Similarly, losartan also increases the amount of uric acid excreted from the body. The drug can reduce uric acid levels in the blood by up to 25 percent.

Unfortunately, not all drugs used in the treatment of high blood pressure are as beneficial.

The researchers found that a variety of other hypertension drugs increase the risk of gout. This increased risk is especially strong in patients taking diuretics.

Diuretics - sometimes called 'water pills' - help your body get rid of sodium (salt) and water. They also seem to increase the amount of uric acid that is reabsorbed into the body, increasing uric acid levels and the risk of gout.

Examples of diuretics include Microzide (hydrochlorothiazide), Zaroxolyn (metolazone), Edecrin (ethacrynic acid), Lasix (furosemide), Inspra (eplerenone), and others.

Although the risk of developing gout was greater among patients taking diuretics, those who took beta blockers, ACE inhibitors, and angiotensin II receptor blockers (with the exception of losartan) also had an increased risk of gout.

Beta blockers - including Inderal LA (propranolol), Sectral (acebutolol), and Tenormin (atenolol) - have been shown to increase levels of uric acid in the blood.

These findings offer doctors guidance on which drugs to prescribe to their hypertension patients - especially for those patients with a higher risk of developing gout, such as heavy alcohol drinkers and diabetes patients.

According to the study's authors, "Our findings may have practical implications in the management of hypertension, particularly among those who are at a higher risk of developing gout."

"Our data suggest that calcium channel blockers or losartan would be preferred to other antihypertensive drugs if prevention of gout is relevant and other determining factors are comparable," they write.

As hypertension is itself a risk factor for gout, doctors should be aware of the gout risk associated with many of these hypertension drugs before prescribing them to their patients.

Doctors who prescribe urate-lowering antihypertensive drugs like losartan and calcium channel blockers could help lower the high rates of combined cases of gout and hypertension.

"Our findings suggest that calcium channel blockers and losartan may be protective against the risk of gout among people with hypertension," the authors write.

For their study, Dr. Choi and colleagues looked at data from 24,768 gout patients between 20 and 79 years of age. They compared this data to that of a random sample of 50,000 matched controls.

The research was supported in part by the National Institutes of Health.

The results are published in the journal BMJ.

Reviewed by: 
Review Date: 
March 1, 2012
Last Updated:
March 6, 2012