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Gout and Diuretics in Hypertensive Patients

Summary and Comment |
January 26, 2012

Gout and Diuretics in Hypertensive Patients

  1. Allan S. Brett, MD

Diuretic use raised risk for gout by several percentage points.

  1. Allan S. Brett, MD

Observational data have suggested that gout is associated independently with both hypertension and diuretic use. In a prospective study, researchers determined incidence of diuretic-associated gout in nearly 6000 hypertensive patients with no histories of gout at baseline.

During 9 years of follow-up, 37% of patients received diuretics. Incidence of gout was 5.5% among diuretic users (5.0% among thiazide users and 7.0% among loop-diuretic users) and 2.9% among patients who did not use diuretics. After adjustment for potentially confounding variables (except serum uric acid), use of thiazides and loop diuretics were both significantly associated with incident gout (hazard ratios, 1.4 and 2.3, respectively). Compared with serum uric acid levels in nonusers of diuretics, levels rose by a mean of 0.65 mg/dL among those who began taking thiazides and 0.96 mg/dL among those who began taking loop diuretics. The association between diuretics and gout was no longer significant after additional adjustment for serum uric acid; this finding is consistent with the assumption that diuretic-induced increases in serum uric acid mediate the association between diuretic use and gout.

Comment

According to these results, diuretic use raises risk for gout by several percentage points in hypertensive patients. Increased risk for gout is among the potential adverse effects of thiazides that clinicians should consider when choosing first-line antihypertensive drugs.

Citation(s):

Reader Comments (5)

LAWRENCE D BROTMAN, MD

I've personally found that Diovan raises serum uric acid and causes subsequent gout. I've determined personally that discontinuing Diovan and substituting losartan, in the same drug category as diovan, is a uricosuric, and eliminates future gouty attacks. It is well known the Diovan causes elevated uric acid. These action are apparently not appreciated in much of the medical community.

Competing interests: None declared

Rabia Akbar Vali

patients with chronic congestive cardiac failure do need diuretics mainly loop diuretics which seems to increase uric acid more than the thiazide,what is one suppose to prescribe/or is it right to use prophylactic allopurinol with the use of loop diuretics?

Competing interests: None declared

mitsuo tomita

It appears the study, as with most studies, did not look at hctz at 12.5mg as compared to 25mg or 50mg. It would be very helpful to know if hctz 12.5mg changes uric a. levels. Does anyone know of such study/studies?

Competing interests: None declared

Venice J Bernard-Wright

I have been treating patients with Hypertension with Thiazide diuretics for forty years, in the earlier days with HCTZ 5omg then 25 mg and more recently 12.5 and 6.25 mg. I have also for the last 15 years or so been using Bendrofluazide 2.5 mg. daily. I must be very lucky for I have not had one case of gout from this medication. Maybe the strength of the dosage is what really matters.

I have been looking for this side effect in my usage but I have not seen it.

Competing interests: None declared

Irma O. Szymanski

I have had moderately severe Hypertension for 20 years and was on 25 mg HCTZ daily plus 2 other meds. 2 years ago developed a painful tophus in one toe and uric acid was 25% over normal range. HCTZ was decreased to 12.5 mg daily and losartan was substituted for another ACE receptor inhibitor. Uric acid normalized. However, later uric acid increased again and HCTZ was decreased to 12.5 3 x week. Wonder if HCTZ in such small amount can increase uric acid or is an underlying gout the problem?

Competing interests: None declared

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