Slide 1: What do you think? Your patient with hypertension also has gout. Which of the following antihypertensives would be preferred in this patient? A) Lisinopril. B) Losartan. C) Amlodipine. D) Hydrochlorothiazide.

Slide 2: Did you know?? B) Losartan, unlike other ARBs, has an independent effect to lower uric acid by increasing its excretion in the nephron. It is a good choice for hypertensive patients with gout.

Slide 3: On the other hand… Hydrochlorothiazide increases uric acid levels. Here is the mechanism: first, the thiazide enters the proximal tubule cell, and then is exchanged with uric acid, driving the reabsorption of urate. Losartan can be added to modulate this effect.

References

  • Manolis AJ, Grossman E, Jelakovic B. Effects of losartan and candesartan monotherapy and losartan/hydrochlorothiazide combination therapy in patients with mild to moderate hypertension. Losartan Trial Investigators. Clin Ther. 2000 Oct;22(10):1186-203. PMID 11110230

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