Am Fam Physician. 2015 Oct 1;92(7):622-623.
Does the use of thiazide diuretics increase the risk of gout?
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.)
REFERENCESshow 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.
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