Hypertension is one of the most common comorbidities of gout. Studies have shown that
the presence of hypertension is independently associated with the risk of
incident gout through reduced renal blood flow with increased renal and
systemic vascular resistance and decreased renal excretion of urate.
Hypertension is the term used to describe high blood pressure. Blood pressure
is a measurement of the force against the walls of your arteries as your heart
pumps blood through your body. Gout is a kind of arthritis that occurs when uric acid builds
up in blood and causes joint inflammation. Acute gout is a painful condition
that typically affects one joint. Chronic gout is repeated episodes of pain and
inflammation, which may involve more than one joint.
To study the risk of incident
gout among patients with hypertension and antihypertensive drugs a study was conducted in United Kingdom between January
2000 and December 2007 in which the data was collected from the health improvement network
database containing the computerized
medical records entered by general practitioners in the United Kingdom. Patients free
of gout and cancer were included in the study.
impact of antihypertensive drugs by class: diuretics, β blockers, calcium
channel blockers, angiotensin converting enzyme inhibitors, losartan, and
non-losartan angiotensin II receptor blockers were evaluated. Dose
of antihypertensive drugs were classified into three groups: medium or low
(recommended starting doses or lower), high (higher than recommended starting
doses), and unknown. From the database data was collected on personal characteristics and
lifestyle factors such as alcohol use, smoking, and body mass index, as well as
comorbidities such as ischaemic heart disease, hypertension, hyperlipidaemia,
renal failure, and heart failure.
The study denoted that in both groups gout was
associated with an increased number of visits to a general practitioner,
alcohol use, adiposity, ischaemic heart disease, hyperlipidemia, and renal
failure. As compared with no use of
calcium channel blockers, current use among people with hypertension was
associated with a lower risk of developing gout.
The relative risks for
individual calcium channel blockers were 0.79 or amlodipine, 0.87 for
nifedipine, and 0.86 (0.75 to 0.99) for diltiazem. The relative risks for
calcium channel blockers according to duration of use among those with
hypertension were 1.04 for less than one year, 0.89 for 1-1.9 years, and 0.77
for two or more years.
In this large general practice cohort
representative of the UK population, it was found that use of calcium channel blockers and losartan was associated with a
moderately lower risk of incident gout among patients with hypertension.
risk of developing gout among those with hypertension was found to be associated
with the use of diuretics, β blockers, angiotensin converting enzyme
inhibitors, and non-losartan angiotensin II receptor blockers. The longer one
uses these antihypertensives the risk of developing gout also increases, except
for β blockers, and non-losartan angiotensin II receptor blockers.
Calcium channel blockers could increase the
glomerular filtration rate and consequently the clearance rates of uric acid
and creatinine. These inverse associations were stronger with both a longer
duration and a higher dose of use.
From a public health perspective it is concluded
that the high comorbidity burden of gout and hypertension can be reduced by
using the urate lowering antihypertensive drugs like calcium channel blockers
which increase the glomerular filtration rate and consequently the clearance
rates of uric acid and creatinine.
Reference: Antihypertensive drugs
and risk of incident gout among patients with hypertension: population based
case-control study; Hyon et al; BMJ 2012.