FPIN's Clinical Inquiries

Risk of Gout with the Use of Thiazide Diuretics


Am Fam Physician. 2015 Oct 1;92(7):622-623.

Clinical Question

Does the use of thiazide diuretics increase the risk of gout?

Evidence-Based Answer

Thiazide diuretics may be used in most patients with hypertension who have only minimally increased risk of gout. (Strength of Recommendation [SOR]: B, based on a single randomized controlled trial [RCT].) There is no increased risk in patients older than 60 years or in women, but there is a slightly increased risk (about 1%) in men younger than 60 years (SOR: B, based on a single RCT.) Usual doses of thiazides (less than 25 mg) are not associated with an increased risk of gout, although doses of 25 mg or greater are. The risk of gout with hydrochlorothiazide and chlorthalidone is similar. Thiazides may be used in patients with asymptomatic hyperuricemia because they are not associated with an increased risk of gout in these patients. (SOR: C, based on retrospective cohort studies.)

To see the full article, log in or purchase access.

Address correspondence to Connie Kraus, PharmD, at connie.kraus@wisc.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Staessen J. The determinants and prognostic significance of serum uric acid in elderly patients of the European Working Party on High Blood Pressure in the Elderly trial. Am J Med. 1991;90(3A):50S–54S....

2. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Lancet. 1981;2(8246):539–543.

3. Gurwitz JH, Kalish SC, Bohn RL, et al. Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol. 1997;50(8):953–959.

4. Wilson L, Nair KV, Saseen JJ. Comparison of new-onset gout in adults prescribed chlorthalidone vs. hydrochlorothiazide for hypertension. J Clin Hypertens (Greenwich). 2014;16(12):864–868.

5. Duskin-Bitan H, Cohen E, Goldberg E, et al. The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort. Clin Rheumatol. 2014;33(4):549–553.

6. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–1446.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.


Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Oct 15, 2016

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article