Hypertension Management in Gout Patients

Antihypertensive Medications and Their Effect on Uric Acid Levels

Thiazide and thiazide-type diuretics increase serum uric acid levels and should be avoided in patients with gout when possible, according to the American Heart Association, as stated in Circulation 4
The European League Against Rheumatism recommends losartan for hypertension management in gout patients due to its uricosuric action, as supported by the European League Against Rheumatism 1, 2

Losartan has a unique uricosuric effect among angiotensin II receptor blockers, lowering serum uric acid by increasing renal uric acid clearance, as reported by the Annals of the Rheumatic Diseases 2
The American College of Cardiology suggests that losartan can be used as an adjunctive therapy to allopurinol or febuxostat in patients with severe gout requiring urate-lowering therapy, as stated in Arthritis and Rheumatology 6, 7

For patients with hypertension and gout/hyperuricemia, losartan should be considered as the preferred antihypertensive agent, according to the European Society of Cardiology, as reported in Annals of the Rheumatic Diseases 2
Avoid combination therapy with ACE inhibitors and ARBs as this is potentially harmful and not recommended for hypertension treatment, as stated in Circulation 4
Fenofibrate has shown uricosuric effects and can lower serum uric acid by approximately 20% in patients with hyperlipidemia and gout, as reported by the Annals of the Rheumatic Diseases 2, 3