The patient is a 58-year-old white male who comes into your ambulatory care clinic for a 6-month follow-up regarding gout and new-onset hypertension. The patient is currently on allopurinol 300 mg po daily, and recently completed his 6-month course of prophylaxis with colchicine 0.6 mg po daily. The patient now has a blood pressure of 136/84 in the clinic. If you wanted to start an antihypertensive that can also lower uric acid levels, which of the following options would be most appropriate?

A. Losartan

B. Furosemide

C. Hydrochlorothiazide

D. Verapamil

E.  Carvedilol

Answer with rationale:

The correct answer is A. 

Both loop and thiazide diuretics can cause hyperuricemia, so B and C are incorrect and other options are preferred. Verapamil and carvedilol do not have any effect on uric acid levels, making options D and E incorrect. Lastly, Losartan can decrease uric acid levels, making it a good choice for patients with gout and comorbid hypertension, making choice A correct. Losartan has a probenecid-like effect inhibiting URAT1, increasing renal excretion of uric acid. This is seemingly unique amongst the ACE inhibitors and ARBs and is a nice pearl to keep in the back of your mind when a patient comes in with gout. Amlodipine is another option that has been shown in a secondary analysis of the ALLHAT trial to reduce the risk of gout flares when it was compared with lisinopril or chlorthalidone.

References:

1. Juraschek SP et al. The effects of antihypertensive class on gout in older adults: secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. J Hyperten. 2020;38: 954-960. 

Competencies covered:
2.1 – Pharmacology, mechanism of action, or therapeutic class

3.7 – Adverse drug effects, toxicology, or overdose

See everyone next week!

Dr. B