From the Guidelines
For patients with gout, losartan is the most suitable blood pressure medication, as it has uricosuric properties that help lower uric acid levels while controlling blood pressure, as conditionally recommended by the 2020 American College of Rheumatology guideline for the management of gout 1. When managing blood pressure in patients with gout, it is essential to consider the effects of antihypertensive medications on uric acid levels.
- Losartan is particularly beneficial, as it not only controls blood pressure but also has uricosuric properties, which help lower uric acid levels, thus potentially reducing the risk of gout flares.
- Calcium channel blockers, such as amlodipine, diltiazem, and nifedipine, are also suitable options, as they are neutral regarding uric acid metabolism and can be safely used without worsening gout.
- Diuretics, especially thiazides like hydrochlorothiazide and loop diuretics like furosemide, should be avoided when possible, as they can raise uric acid levels and potentially trigger gout flares, with the 2020 American College of Rheumatology guideline conditionally recommending switching hydrochlorothiazide to an alternate antihypertensive when feasible 1. The choice of blood pressure medication in patients with gout should prioritize those that do not adversely affect uric acid levels, with losartan being a preferred option due to its additional uricosuric effects, as supported by the conditional recommendation to choose losartan preferentially as an antihypertensive agent when feasible 1.
From the FDA Drug Label
Hyperuricemia: Hyperuricemia or acute gout may be precipitated in certain patients receiving thiazide diuretics.
Thiazide diuretics, such as hydrochlorothiazide, may not be suitable for patients with gout as they can precipitate hyperuricemia or acute gout.
- Patients with gout should be cautious when taking thiazide diuretics.
- Alternative blood pressure medications may be considered for patients with gout 2.
From the Research
Suitable Blood Pressure Medications for Patients with Gout
- Losartan is a suitable blood pressure medication for patients with gout, as it has been shown to decrease serum uric acid levels 3, 4, 5, 6.
- Losartan's uricosuric effect can help lower serum uric acid levels, making it a useful therapeutic tool for controlling blood pressure and reducing serum uric acid levels in hypertensive patients with hyperuricemia and gout 3.
- Other angiotensin II receptor blockers, such as irbesartan, do not have the same uricosuric effect as losartan 3, 6.
- Diuretics, beta-blockers, and alpha-1 blockers may increase serum uric acid levels and reduce glomerular filtration rate, making them less suitable for patients with gout 4.
- Calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers, including losartan, do not increase serum uric acid levels 4.
Key Considerations
- Losartan is the only angiotensin II receptor blocker that has consistently demonstrated a significant reduction in serum uric acid levels 5, 6.
- The addition of or switch to losartan as an antihypertensive agent for patients with gout is recommended by clinical guidelines due to its benefit as a uricosuric agent 5.
- Patients with gout should be carefully monitored for changes in serum uric acid levels and kidney function when starting or switching blood pressure medications 4, 7.