From the Guidelines
Patients with obesity, hypertension, and a family history of gout should be managed with a comprehensive approach addressing all three conditions simultaneously, prioritizing weight loss, dietary modifications, and careful selection of antihypertensive medications to minimize gout risk.
Key Components of Management
- Weight loss should be encouraged through a combination of caloric restriction and regular physical activity, aiming for a 5-10% reduction in body weight initially, as supported by the most recent evidence from 1.
- Dietary modifications should include limiting purine-rich foods (organ meats, shellfish, red meat), reducing alcohol intake (especially beer), avoiding high-fructose corn syrup, and following the DASH diet which emphasizes fruits, vegetables, whole grains, and low-fat dairy products.
- For hypertension management, first-line medications should include ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs (such as losartan 50-100 mg daily), as these medications can help with both blood pressure control and may have uricosuric effects that benefit gout risk, as recommended by 1 and 1.
Considerations for Gout Management
- Thiazide diuretics should be avoided when possible as they can increase uric acid levels and trigger gout attacks.
- Regular monitoring of blood pressure (target <130/80 mmHg) and uric acid levels is essential.
- If gout symptoms develop, acute attacks can be treated with colchicine (1.2 mg followed by 0.6 mg one hour later), NSAIDs, or corticosteroids, following the guidelines outlined in 1 and 1.
- For those with recurrent gout attacks, preventive therapy with allopurinol (starting at 100 mg daily and titrating up) or febuxostat may be indicated, as discussed in 1 and 1. This integrated approach addresses the underlying metabolic factors that contribute to all three conditions while minimizing the risk of medication interactions or exacerbation of comorbidities.
From the Research
Management of Patients with Obesity, Hypertension, and a Family History of Gout
- Patients with obesity, hypertension, and a family history of gout are at increased risk of developing gout, with obesity, hypertension, and diuretic use each more than doubling the risk compared to those without these risk factors 2.
- Losartan, an angiotensin II receptor blocker, has been shown to significantly lower uric acid levels and is recommended as an antihypertensive agent for patients with gout due to its uricosuric properties 3, 4, 5.
- The diagnosis of gout can be made using several validated clinical prediction rules, and arthrocentesis should be performed when suspicion for an underlying septic joint is present 6.
- Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 6.
- Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids can relieve pain in adults with acute gout episodes, while allopurinol and febuxostat can be used to prevent flare-ups, although febuxostat is associated with an increase in all-cause and cardiovascular mortality 6.
Risk Factors and Prevention
- Obesity, hypertension, and diuretic use are significant risk factors for incident gout, and patients with these risk factors should be recognized by clinicians as being at greater risk of developing gout and provided with appropriate management and treatment options 2.
- A diet rich in meat and seafood, alcohol intake, and a diet heavy in fructose-rich food and beverages are also risk factors for gout 6.
- Losartan may be a useful treatment option for patients with hypertension and gout, as it has been shown to lower uric acid levels and reduce the risk of gout attacks 3, 4, 5.