From the Guidelines
Losartan is generally considered the best hypertension medication for patients with gout. This angiotensin II receptor blocker (ARB) not only effectively lowers blood pressure but also has uricosuric properties, meaning it helps the kidneys eliminate uric acid from the body, which can help prevent gout flares 1. The typical starting dose is 50 mg once daily, which can be increased to 100 mg daily if needed for blood pressure control. Other ARBs like valsartan or irbesartan may also be beneficial but have less evidence for gout benefits specifically.
Some key points to consider when managing hypertension in patients with gout include:
- Avoiding thiazide and loop diuretics, such as hydrochlorothiazide or furosemide, as they can increase uric acid levels and potentially trigger gout attacks 1
- Using losartan as a first-line treatment for hypertension in patients with gout, due to its uricosuric properties and effectiveness in lowering blood pressure 1
- Considering alternative antihypertensive medications, such as ACE inhibitors or calcium channel blockers, if losartan is not tolerated or effective 1
- Monitoring uric acid levels and adjusting treatment as needed to prevent gout flares 1
It's also important to note that losartan works by blocking the hormone angiotensin II, which relaxes blood vessels while simultaneously increasing uric acid excretion through effects on the URAT1 transporter in the kidneys 1. This dual action makes it particularly valuable for patients managing both hypertension and gout simultaneously.
In terms of specific dosing and administration, losartan can be started at a dose of 50 mg once daily and increased to 100 mg daily if needed for blood pressure control 1. However, the exact dosing and administration will depend on the individual patient's needs and medical history.
Overall, losartan is a valuable treatment option for patients with hypertension and gout, due to its effectiveness in lowering blood pressure and preventing gout flares 1.
From the Research
Hypertension Medications and Gout
- The study 2 found that calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension, due to their urate-lowering properties.
- In contrast, diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout 2.
- A study comparing nifedipine and amlodipine, both calcium channel blockers, found that they are comparably safe and effective treatment options in patients with mild-to-moderate essential hypertension 3.
- Another study found that the fixed combination of ramipril (an ACE inhibitor) and amlodipine (a calcium antagonist) represents a first-choice therapy for hypertension, according to the 2018 ESH/ESC guidelines 4.
- A post hoc analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that neither amlodipine nor lisinopril was superior to chlorthalidone (a diuretic) in reducing the rate of development of end-stage renal disease or a 50% or greater decrement in GFR in hypertensive patients with reduced GFR 5.
Best Hypertension Medication for Gout
- Based on the available evidence, calcium channel blockers such as amlodipine and nifedipine, as well as losartan, may be good options for hypertension treatment in patients with gout, due to their potential to lower urate levels and reduce the risk of gout attacks 2, 3.
- However, it is essential to consider individual patient characteristics, comorbidities, and potential interactions with other medications when selecting a hypertension medication for patients with gout.