Research

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

BMJ 2012; 344 doi: 10.1136/bmj.d8190 (Published 12 January 2012)
Cite this as: BMJ 2012;344:d8190
  1. Hyon K Choi, professor of medicine1,
  2. Lucia Cea Soriano, epidemiologist2,
  3. Yuqing Zhang, professor of medicine1,
  4. Luis A García Rodríguez, director2
  1. 1Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118, USA
  2. 2Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
  1. Correspondence to: H K Choi hchoius{at}bu.edu
  • Accepted 4 November 2011

Abstract

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.

Footnotes

  • Contributors: All authors conceived and designed the study and analysed the data. HKC drafted the manuscript and is guarantor. All authors helped interpret the results.

  • Funding: This work was supported in part by grants from the National Institutes of Health (AR056291 and P60AR047785). The Spanish Centre for Pharmacoepidemiological Research has received an unrestricted research grant from Novartis to work on other projects related to gout. The funding sources had no role in the design, conduct, or reporting of the study or in the decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that HKC has received research funding for other projects from Takeda Pharmaceuticals and has served on advisory boards for Takeda Pharmaceuticals, Savient Pharmaceuticals, and URL Pharma; the authors have no relationship with companies that might have an interest in the submitted work in the previous three years; they have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: This study was approved by the National Health Service research ethics committee (09/H0305/75).

  • Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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