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Antihypertensive Drugs and Risk of Incident Gout Among Patients With Hypertension
Hyon K Choi; Lucia Cea Soriano; Yuqing Zhang; Luis A García Rodríguez
BMJ © 2012 BMJ Publishing Group

Voir également : Hyperuricémie - Goutte :Une correction de diététique s'impose[Lire]

Les inhibiteurs calciques et le losartan font baisser l'uricémie et diminuent le risque de crise de goutte chez les patients hypertendus. En comparaison, les diurétiques, les bêta-bloquants, les IEC et les autres ARAII sont associés à un risque majoré de goutte.

Objective To determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension.
Design Nested case-control study.
Setting UK general practice database, 2000-7.
Participants All incident cases of gout (n=24,768) among adults aged 20-79 and a random sample of 50,000 matched controls.
Main outcome measure Relative risk of incident gout associated with use of antihypertensive drugs.
After adjusting for age, sex, body mass index, visits to the general practitioner, alcohol intake, and pertinent drugs and comorbidities, the multivariate relative risks of incident gout associated with current use of antihypertensive drugs among those with hypertension (n=29,138) were 0.87 (95% confidence interval 0.82 to 0.93) for calcium channel blockers, 0.81 (0.70 to 0.94) for losartan, 2.36 (2.21 to 2.52) for diuretics, 1.48 (1.40 to 1.57) for ß blockers, 1.24 (1.17 to 1.32) for angiotensin converting enzyme inhibitors, and 1.29 (1.16 to 1.43) for non-losartan angiotensin II receptor blockers. Similar results were obtained among those without hypertension. The multivariate relative risks for the duration of use of calcium channel blockers among those with hypertension were 1.02 for less than one year, 0.88 for 1-1.9 years, and 0.75 for two or more years and for use of losartan they were 0.98, 0.87, and 0.71, respectively (both P<0.05 for trend).
Conclusions
Our findings suggest that calcium channel blockers and losartan may be protective against the risk of gout among people with hypertension. These data are compatible with previous findings that suggested these drugs have urate lowering properties. In contrast, diuretics, ß blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout. These data may have practical implications for choosing the appropriate antihypertensive drugs in patients with hypertension, a common comorbidity of gout.

What is Already Known on This Topic
  • Hypertension is a common comorbidity of gout, affecting up to 74% of patients with gout
  • Unlike other antihypertensives, calcium channel blockers and losartan may reduce the risk of gout by lowering urate acid levels
  • Compatible with their urate lowering properties, calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension
  • By contrast, diuretics, ß blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that HKC has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda Pharmaceuticals, Savient Pharmaceuticals, and URL Pharma; the authors have no relationship with companies that might have an interest in the submitted work in the previous three years; they have no non-financial interests that may be relevant to the submitted work.
Ethical approval: This study was approved by the National Health Service research ethics committee (09/H0305/75)
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