Antihypertensive Drug Linked to Lower Long-Term Risk of Gout

Antihypertensive drug amlodipine lowered the long-term risk of gout compared with 2 other medications commonly used to lower blood pressure, according to a new study published in the Journal of Hypertension.  

Characterized by a sudden onset of pain, swelling, and stiffness in the joints, gout is a common complication of blood pressure management, often leading to medication nonadherence. However, there has been limited research on treatment guidance regarding specific antihypertensive medications for patients at high risk for gout.

The study, called the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), evaluated the effects of first-line hypertension therapy with amlodipine, chlorthalidone, or lisinopril on fatal coronary heart disease or nonfatal myocardial infarction. To assess the effect on gout risk, the researchers used Centers for Medicare and Medicaid Services (CMS) and Veteran Affairs (VA) gout claims from 23,964 participants treated at 623 medical centers between 1994 and 2002.

According to the data, atenolol use was reported by 928 patients at the 1-month visit. Over approximately 5 years, the researchers documented 597 gout claims.

Overall, amlodipine reduced the risk of gout by 37% (hazard ratio 0.63; 95% CI 0.51-0.78) compared with chlorthalidone and by 26% (hazard ratio 0.74, 95% CI 0.58-0.94) compared with lisinopril, according to the study.

The results also showed that lisinopril lowered gout risk when compared with chlorthalidone, but the findings were nonsignificant (hazard ratio 0.85; 95% CI 0.70-1.03).

Atenolol use was not shown to be associated with gout risk (adjusted hazard ratio 1.18; 95% CI 0.78-1.80) and gout risk reduction was primarily observed after 1 year of follow-up.

“Our study is clinically relevant as the prevalence of gout has been rising in the United States and the number of Americans meeting newly-revised diagnostic thresholds for hypertension has doubled,” corresponding study author Stephen Juraschek, MD, PhD, assistant professor of medicine at Beth Israel Deaconess Medical Center, said in a press release about the findings. “Our study demonstrated that amlodipine was associated with a lower risk of gout compared with chlorthalidone or lisinopril, which has never been reported prior to this study.”