Treatment with amlodipine was found to be more effective in reducing the long-term risk for gout compared with treatment with lisinopril or chlorthalidone in older adults with hypertension, according to a study published in the Journal of Hypertension.

In this secondary analysis of the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ClinicalTrials.gov Identifier: NCT00000542), the effect on gout risk of first-step antihypertensive medications was assessed in 23,964 adults (mean age, 69.8±6.8 years) with hypertension and ≥1 risk factor for coronary heart disease. First-step antihypertensive treatments examined were 2.5 mg to 10 mg amlodipine, 12.5 mg to 25 mg chlorthalidone, and 10 mg to 40 mg lisinopril. Gout was identified using claims from the Centers for Medicare and Medicaid Services and Veterans Affairs hospitalization data.

A total of 597 gout claims were documented over a median follow-up period of 4.9 years. During this period, treatment with amlodipine reduced the risk of gout by 37% compared with chlorthalidone (hazard ratio [HR], 0.63; 95% CI, 0.51-0.78; P <.001) and by 26% compared with lisinopril (HR, 0.74; 95% CI, 0.58-0.94; P =.012). Lisinopril did not lower the risk of gout to a greater extent than chlorthalidone (HR, 0.85; 95% CI, 0.70-1.03; P =.10). Use of atenolol was not associated with a risk for gout (adjusted HR, 1.18; 95% CI, 0.78-1.80; P =.43). The superior effects of amlodipine compared with the other 2 drugs were more prominent after 1 year: compared with chlorthalidone (HR, 0.55; 95% CI, 0.43-0.71; P <.001) and compared with lisinopril (HR, 0.65; 95% CI, 0.50-0.86; P =.002).

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Limitations of the study include the lack of baseline assessment of participants’ gout history and alcohol use.

 “[O]ur findings suggest the potential for substantial reduction of suffering by use of amlodipine in this population,” concluded the study authors.

Reference

Juraschek SP, Simpson LM, Davis BR, et al. The effects of antihypertensive class on gout in older adults: secondary analysis of the antihypertensive and lipid-lowering treatment to prevent heart attack trial [published online January 20, 2020]. J Hypertens. doi: 10.1097/HJH.0000000000002359