Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study

• Published in: BMJ Vol. 344; no. 7843; p. 18
• Main Authors: Choi, Hyon K, Soriano, Lucia Cea, Zhang, Yuqing, Rodríguez, Luis A García
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 12.01.2012; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Alcoholic beverages; Angiotensin; Angiotensin II; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Antihypertensives; Blood pressure; Body mass; Body mass index; Calcium; Case control studies; Chemotherapy; Degenerative joint disease; Diuretics; Drug development; Drugs; Drugs: cardiovascular system; Drugs: CNS (not psychiatric); Drugs: musculoskeletal and joint diseases; Epidemiologic studies; Female; Follow-Up Studies; General practice / family medicine; Gout; Gout - chemically induced; Gout - epidemiology; Humans; Hypertension; Hypertension - drug therapy; Hypertension - epidemiology; Incidence; Male; Metabolic disorders; Metabolism; Middle Aged; Musculoskeletal syndromes; Peptidyl-dipeptidase A; Pharmaceutical preparations; Population; Population studies; Population Surveillance; Population-based studies; Prognosis; Retrospective Studies; Rheumatism; Risk assessment; Risk Factors; United Kingdom - epidemiology; Uric acid; Young Adult; United Kingdom > UK; British Isles
• ISSN: 0959-8138; 1756-1833; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.d8190

Objective To determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension.Design Nested case-control study.Setting UK general practice database, 2000-7.Participants All incident cases of gout (n=24 768) among adults aged 20-79 and a random sample of 50 000 matched controls.Main outcome measure Relative risk of incident gout associated with use of antihypertensive drugs.Results After adjusting for age, sex, body mass index, visits to the general practitioner, alcohol intake, and pertinent drugs and comorbidities, 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 β 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).Conclusions Compatible with their urate lowering properties, calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension. By contrast, diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout.