The authors of this nested case control study aimed to determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension. The authors note that some particular antihypertensive drugs (such as beta blockers) have been shown to increase the levels of serum uric acid and hence may contribute to the risk of gout. However, others (such as calcium channel blockers and losartan) have been found to lower serum uric acid levels, carrying the potential to lower the risk of gout. They analysed a cohort of 24,768 people with newly diagnosed gout (incident cases) and 50,000 random matched controls from the UK general practice database. This database contains computerised medical records entered by general practitioners in the UK. The study used data collected in the database between January 2000 and December 2007. 

The results found (from source):

• After adjusting for age, sex, body mass index, visits to the general practitioner, alcohol intake, and pertinent drugs and co-morbidities, 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 beta 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).

The authors conclude, “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, beta 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 co-morbidity of gout.”

The author of a related editorial discusses the results of this study and notes, “In summary, hypertension and hyperuricaemia commonly coexist. Antihypertensive drugs can increase or decrease the development of incident gout in patients with hypertension, with losartan and calcium channel blockers having the greatest lowering effect on blood pressure because of their uricosuric properties. As well as reducing incident gout, a decrease in the concentration of serum uric acid could also improve the cardiovascular and renal prognosis of patients with hypertension.”