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  • #2847
    Al O’Purinol

    I, my Son, and my Nephew all suffer from gout. We all have one thing in common, we never had gout until we started taking an ace inhibitor for blood pressure.

    I have not seen this discussed on any website. Has anyone else had this problem? I feel there has to be some connection.


    Previous discussion on high blood pressure treatment on gout focussed on ACE inhibitors as a better alternative to diuretics.

    Whilst ACE inhibitors seem preferable to diuretics, it seems they are not the best solution for those prone to gout.

    In “The effect of ACE inhibitor and angiotensin II receptor antagonist therapy on serum uric acid levels and potassium homeostasis in hypertensive renal transplant recipients treated with CsA”, Schmidt and colleagues found a slight rise in uric acid after administration of enalapril, an ACE inhibitor. They compared that with losartan, which has several mentions around here (type losartan in the search box above or at the foot of every page).

    Their results show that, after 3 weeks of treatment, the losartan subjects average uric acid level reduced from 7.8 to 7.3, whereas the enalapril subjects increased from 7.8 to 8.2.

    This isn't a perfect example, as it studies kidney transplant patients. If anyone has more information, I'd love to read it.

    In the meantime, Roy, I suggest you, your son and your nephew have a word with your doctors about changing the blood pressure meds.



    My gout, too, was precipitatied with antihypertensives but for me the drug was hydrochlorothiazide, the commonest diuretic and the first line of treatment for hypertension for decades. I was in my 30's at the time.

    BUT if you examine the way ALL antihypertensive drugs ultimately work, it's through diuresis the only differences is in the route they GET there. There is one rnegade in the bunch which is also a uricosuric drug and that is losartan. A GOOD drug for gout sufferers but, alas no the best antihypertensive and thus it must often be combined with a diuretic for effectiveness. It goes by the brand name COZAAR and unfoirtunately is not yet available as a cheap diuretic.

    Cozaar + Diuretic is a good treatment because the losartan at least outweighs the gouty effects of the diuretic.

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