What medication is suitable for a patient with a history of hypertension and gout?

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From the Guidelines

Losartan is a suitable medication for a patient with a history of hypertension and gout.

Reasons for this choice

  • According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, losartan is an angiotensin II receptor blocker (ARB) that can be used to treat hypertension.
  • The 2020 American College of Rheumatology guideline for the management of gout 1 conditionally recommends choosing losartan preferentially as an antihypertensive agent when feasible for patients with gout, regardless of disease activity.
  • Additionally, the 2016 updated EULAR evidence-based recommendations for the management of gout 1 suggest that losartan can be considered for treating hypertension in patients with gout.
  • The 2020 International Society of Hypertension global hypertension practice guidelines 1 also recommend losartan as a treatment option for hypertension in patients with elevated serum uric acid levels.

Key considerations

  • Losartan has a uricosuric effect, which can help lower serum uric acid levels and reduce the risk of gout flares.
  • It is essential to monitor the patient's serum uric acid levels and adjust the treatment plan as needed to achieve optimal control of both hypertension and gout.
  • Other medications, such as calcium channel blockers, may also be considered as alternative treatment options for hypertension in patients with gout.

From the Research

Suitable Medications for Hypertension and Gout

  • Calcium channel blockers, such as amlodipine, have been shown to reduce the risk of gout 2, 3
  • Losartan, an angiotensin II receptor blocker, has been found to lower uric acid levels and is recommended for patients with gout 4, 5, 3
  • ACE inhibitors, such as lisinopril, may have a neutral effect on gout risk, but their use should be considered on a case-by-case basis 2, 3

Medications to Avoid

  • Diuretics, beta-blockers, and alpha-1 blockers may increase the risk of gout due to their effects on uric acid metabolism and glomerular filtration rate 4, 3
  • Non-losartan angiotensin II receptor blockers may also be associated with an increased risk of gout 3

Considerations for Treatment

  • The selection of antihypertensive medications should take into account the patient's risk of gout and other comorbidities 2, 6, 3
  • Urate-lowering therapy, such as allopurinol or probenecid, may be necessary for patients with gout and hypertension 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Hyperuricemia and Gout: The Role of Losartan.

The Senior care pharmacist, 2023

6
Research

Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure.

American journal of cardiovascular drugs : drugs, devices, and other interventions, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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