What gout medication does not exacerbate hypertension?

From the Guidelines

Allopurinol is the recommended gout medication that does not exacerbate hypertension, as it is a xanthine oxidase inhibitor that reduces uric acid production without affecting blood pressure. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, allopurinol is recommended as the first-line urate-lowering therapy (ULT) for patients with gout, starting at a low dose of 100 mg/day and increasing by 100 mg increments every 2-4 weeks if required. This approach is supported by studies showing the efficacy, low cost, and safety of allopurinol.

Some key points to consider when prescribing allopurinol include:

• Starting at a low dose and titrating upward until the target serum uric acid (SUA) level is reached
• Maintaining an SUA level of <6 mg/dL (360 mmol/L) lifelong
• Monitoring liver function regularly
• Continuing the medication long-term, even when not experiencing acute gout attacks

In contrast to other gout medications, such as NSAIDs and corticosteroids, which can potentially raise blood pressure, allopurinol is generally considered safe for patients with hypertension. Febuxostat, another xanthine oxidase inhibitor, is also a viable option for patients who cannot tolerate allopurinol or have renal impairment 1. However, allopurinol remains the first-line treatment due to its established efficacy and safety profile.

From the Research

Gout Medication Options

• Febuxostat is a non-purine, selective inhibitor of xanthine oxidase that can be used to manage hyperuricaemia in patients with gout 2, 3, 4, 5, 6.

Hypertension Considerations

• There is no direct evidence to suggest that febuxostat exacerbates hypertension 2, 3, 4, 5, 6.

Key Benefits of Febuxostat

• Febuxostat does not require dosage adjustment in patients with mild or moderate renal impairment 3.
• It has been shown to be effective in lowering serum uric acid levels in patients with hyperuricaemia and gout, including those with renal impairment 3, 6.
• Febuxostat is generally well tolerated, with the majority of treatment-related adverse events being transient and mild-to-moderate in severity 2, 4.

Potential Adverse Events

• Cardiovascular events were the most common serious adverse events reported in clinical trials 3.
• Liver function abnormalities, diarrhoea, and rash were also frequently reported adverse events 3, 4.