Antihypertensive Medication Could Reduce Gout Risk

Stephen Juraschek, MD, PhD

New data from an analysis of more than 20,000 participants found an antihypertensive medication could help protect some older patients from developing gout.

Results of the study, which was a secondary analysis of data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), indicated use of amlodipine was associated with a lower long-term risk of gout compared with lisinopril or chlorthalidone.

Performed by a team of physicians from the Beth Israel Deaconess Medical Center (BIDMC), the National Institutes of Health-sponsored study sought to compare the effects of first-step hypertension therapy with amlodipine, chlorthalidone, and lisinopril in patients with fatal coronary heart disease or nonfatal myocardial infarction. Using claims data, investigators examined the effect of the aforementioned medications in patients from 623 medical centers in North America from 1994 to 2002.

Of the more than 40,000 patients aged 55 and older included in the original study, 23,964 participants were included in the current analysis. The mean age of the participants included was 69.8±6.8 years, 45% of the cohort was women, and 31% was black.

For inclusion in the analysis, patients needed to have a systolic blood pressure of at least 140 mmHg or diastolic blood pressure of at least 90 mmHg and at least 1 risk factor for coronary heart disease. Risk factors included previous stroke, previous myocardial infarction, left ventricular hypertrophy, type 2 diabetes, being a current smoker, or low HDL-cholesterol.

Over a median follow-up period of 4.9 years, investigators observed a total of 597 gout claims from the study population. Of the 23,964 participants, 6522 received amlodipine, 11,000 received chlorthalidone, and 6442 received lisinopril.

Upon analysis, amlodipine reduced the risk of gout by 37% compared with chlorthalidone (HR: 0.63; 95% CI, 0.51 - 0.78) and by 26% (HR: 0.74; 95% CI, 0.58 - 0.94) when compared with lisinopril. Analyses also revealed lisinopril nonsignificantly lowered a patient’s risk of gout compared with chlorthalidone (HR: 0.85; 95% CI 0.70 - 1.03). Investigators pointed out atenolol was not associated with gout risk (aHR: 1.18; 95% CI, 0.78 - 1.80) and most gout risk reduction was primarily observed after 1 year of follow-up.

Based on the results of the trial, investigators suggest amlodipine use could lower a patient’s long-term gout risk compared with lisinopril or chlorthalidone. Further suggesting this information could prove useful in cases where gout risk is a concern among patients receiving treatment for hypertension.

"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," said investigator Stephen Juraschek, MD, PhD, assistant professor of medicine at BIDMC, in a press release. "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."

This study, titled “The effects of antihypertensive class on gout in older adults: Secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial,” was published online in the Journal of Hypertension.