Objectives:
Gout is a common complication of blood pressure management and a frequently cited cause of medication nonadherence. Little trial evidence exists to inform antihypertensive selection with regard to
gout risk.
Methods:
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized clinical trial on the effects of first-step
hypertension therapy with amlodipine,
chlorthalidone, or
lisinopril on fatal coronary heart disease or nonfatal myocardial infarction (1994–2002). Trial participants were linked to CMS and VA
gout claims (ICD9 274.XX). We determined the effect of drug assignment on
gout with Cox regression models. We also determined the adjusted association of self-reported
atenolol use (ascertained at the 1-month visit for indications other than
hypertension) with
gout.
Results:
Claims were linked to 23 964 participants (mean age 69.8 ± 6.8 years, 45% women, 31% black).
Atenolol use was reported by 928 participants at the 1-month visit. Over a mean follow-up of 4.9 years, we documented 597
gout claims. Amlodipine reduced the risk of
gout by 37% (hazard ratio 0.63; 95% CI 0.51--0.78) compared with
chlorthalidone and by 26% (hazard ratio 0.74; 95% CI 0.58--0.94) compared with
lisinopril.
Lisinopril nonsignificantly lowered
gout risk compared with
chlorthalidone (hazard ratio 0.85; 95% CI 0.70--1.03).
Atenolol use was not associated with
gout risk (adjusted hazard ratio 1.18; 95% CI 0.78--1.80).
Gout risk reduction was primarily observed after 1 year of follow-up.
Conclusion:
Amlodipine lowered long-term
gout risk compared with
lisinopril or
chlorthalidone. This finding may be useful in cases where
gout risk is a principal concern among patients being treated for
hypertension.
This trial is registered at clinicaltrials.gov, number: NCT00000542.