Archief Roodbont

Observational data have suggested that gout is associated independently with both hypertension and diuretic use. In a prospective study, researchers determined incidence of diuretic-associated gout in nearly 6000 hypertensive patients with no histories of gout at baseline.

During 9 years of follow-up, 37% of patients received diuretics. Incidence of gout was 5.5% among diuretic users (5.0% among thiazide users and 7.0% among loop-diuretic users) and 2.9% among patients who did not use diuretics. After adjustment for potentially confounding variables (except serum uric acid), use of thiazides and loop diuretics were both significantly associated with incident gout (hazard ratios, 1.4 and 2.3, respectively). Compared with serum uric acid levels in nonusers of diuretics, levels rose by a mean of 0.65 mg/dL among those who began taking thiazides and 0.96 mg/dL among those who began taking loop diuretics. The association between diuretics and gout was no longer significant after additional adjustment for serum uric acid; this finding is consistent with the assumption that diuretic-induced increases in serum uric acid mediate the association between diuretic use and gout.

Comment: According to these results, diuretic use raises risk for gout by several percentage points in hypertensive patients. Increased risk for gout is among the potential adverse effects of thiazides that clinicians should consider when choosing first-line antihypertensive drugs.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 26, 2012