Uric Acid and Blood Pressure Medication

June 9, 2009 in Gout Related, Gout Remedies Forum For Gout Treatment

Uric Acid And Blood Pressure Medication

The link between uric acid and blood pressure medication is just one aspect of the relationship between gout and high blood pressure (hypertension).

In fact, hypertension, high blood pressure, or diuretic in the Gout Search Engine (at the foot of every page, and elsewhere throughout the site) will reveal a wealth of information.

You might know that diuretics prescribed for high blood pressure are a common cause of gout. This need not be so.

With the right approach, it is actually possible to lower uric acid with blood pressure medication.

Back in May,

zip2play said:

My research has shown one antihypertensive regimen that lowers uric acid.  I will repeat it here.

It involves the use of two antihypertensive drugs, furosemide and losartan, (Lasix and Cozaar) but they must be taken in a particular way: first take the Lasix (which causes brisk diuresis) and then several hours later, take the Cozaar which causes uric acid elimination. Dosage of both drugs is titrated to get reasonable blood pressure control. Needless to say, people with NORMAL BP should not use this regimen.

The study confirming this regimen is small but rather convincing, but studies showing the uricosuric effect of losartan are all over the net. It;s the ONLY antihypertensive with this capability but used alone its effect is not large.

The name of the study is “Effects of the uricosuric action by losartan on the patients taking furosemide”, and the results show clearly in the chart above.

Furosemide alone raises uric acid on average by one third. If it is taken at the same time as losartan, then this increase is reduced to just over one fifth.

Losartan alone gives a slight reduction in uric acid, but as zip2play has pointed out in the gout forum, it is not especially effective at reducing high blood pressure. The correct procedure for gout sufferers with high blood pressure, as described by zip2play, is to take losartan a few hours after taking furosemide. The study shows that this can promote an average 15% drop in uric acid.

If you are not on this regime, discuss it with your doctor today. If you are, share your experience in the Gout Cure Forum.


Find more (see gouty search hints).

 

35 responses to Uric Acid and Blood Pressure Medication

  1. trev said on June 9, 2009

    I tried Cozaar earlier this year having completely stopped Thiazides due to Gout.
    As the gout has persisted at reduced level and my BP stays too high, missing the diuretic probably, I must propose this regime- as I’m on multiple angiotensin modifiers anyway !
    This puts Cozaar into a ‘buffer’role and nothing wrong in that.

    • What on earth are Thiazides, multiple angiotensin modifiers, and a ‘buffer’role ?

      I, and most of my readers, have little or no medical knowledge.

      I haven’t a clue how this relates to the losartan-wait-furosemide treatment.

  2. trev said on June 9, 2009

    Thiazides are diuretics of which I was taking Bendromethfluthiazide for many years – up to 5mg dropping back to 2.5 when gout presented itself a few years back.
    I finally stopped this drug last year but it took 6 weeks to stablilise BP but not low enough so I lost my self employment due to failing a medical.
    I got onto Losarten after seeing reports of the UA lowering effect. This drug was stopped later – but if I’d known of the added effect of taking staggered Furosemide -I would have switched to that by choice.
    They seem to potentiate each other if taken apart and this is new to me.
    Buffering refers to the acid lowering effect that indicates.
    Angiotensin2 antagionists[Losarten] , inhibitors and blockers are all drugs acting on the circulation directly by expanding arteries and I take both the latter now.
    I suppose one question is- does this diuretic Furosemide have a wider role with all such drugs?
    I suppose this topic should now move to the forum -but I have little more to add right now.
    I’m not a medic either- but it pays to take an interest…

    • Well, I ‘ve got the go ahead to try this combo. I’ll keep you posted but it will take some weeks to see any results from previous experience and I’m taking it easy on dose size.
      Diuretics are so implicated in Gout causation- that this one exception is really noteable , and if generally successful and used more widely in time ,will remove a lot of gout misery.
      I intend to continually assess my diet, fluid intake etc. in the process and the gout connection could take months to verify
      ( Hopefully !!)

      • Well, I ‘ve got the go ahead to try this combo.

        Out of interest, did this need persuasion, or was you doc already aware of the benefits of this combo?

  3. My history was gout CAUSED by thiazide diuretics after taking them several years.
    Just a teeny background on hypertension: There are basically two types and most doctors don’t recognize the distinction. There is Renin driven 75% ( which makes angiotensin which makes angiotensin 2 which is the most potent hypertensive) and then there are the salt driven hypertensives…the other 25%. The SALT driven (coincidentally most black races) have little benefit from any antihypertensives except diuretics. I’m in that minority, albeit white.

    I have read that furosemide alone is only 25% as likely to exacerbate gout than thiazide diuretics (most commonly hydrochlorothiazide.) That prompted me to switch several years ago. The major difference between the thiazides and the loop (Lasix) is the location of action in the kidney. The thiazides dump copious sodium and the water that follows it, the loop diuretic dumps WATER. (If you taste your urine the difference is astounding.)
    It seems the loss of sodium cannot be accomplished without the retention of urate.

    A sidebar here is that on thiazides I ALWAYS ran severely low sodium levels, to the point where doctors were concerned I was still standing…my sodium remains perfectly normal on Lasix (furosemide…the loop diuretic.)

    So the glib condemnation of diuretics in learned tomes on gout is only half the story.

    When I read that losartan was uricosuric, I added it hoping to at least keep my uric acid stable. What a joy to find that these kindly considerate Japanese researchers had found a way to do even better…to LOWER my uric acid.

    Someday when I am brave, I will try a regimen of only the Lasix followed later by Cozaar…and stop my allopurinol for a couple months. I’d have done it already but for the presence of a single tophus on my little finger. But I so dread an acute attack, pussy that I am!.

    The lasix-cozaar combo gives me very good BP control…<130/<75

  4. The hospital consultant was very straight on tbh. He had not heard of the ‘combo’ being useful for Hypertension/Gout- but we had a good head to head about BP treatment issues ,and I think he accepted what I said in good faith.
    I am fairly confident and read up on what bothers me, like a lot online and here.
    He said two things that were new to me-
    One that diuretics are dropped too easily (gout and other side effects ,I suppose) and also that other issues like Hyperlipids and pre-diabetes are far less important to ongoing good health than the bad effects of continuing high BP.
    Gout would probably fall into the same camp- though I’ve never found this ailment treated lightly by medics, even if it is low profile.
    Possibly just a lack of focus- in a sufferer catchment naturally hitting their later years.
    Also -I see increasing awareness of high SUA as implicated in many other illnesses and maybe this will help gout sufferers by default, in time.
    I did subsequently forward the Japanese link to him.
    Finally ,my thoughts on this topic align with yours in gout treatment, viz: the ongoing need to monitor blood electrolytes on diuretics and combinations of them -in the same way as should be ‘de rigour’ for Allopurinol treatment in gout.
    This may affect resource decisions around the ‘early dropping’ of ongoing diuretic use in high BP.

  5. This article is a very useful overview of drug induced gout and also covers other issues like incidence of rates with specific drugs & conditions: http://www.goutpal.com/1512/beware-gout-cures-you-do-not-need/drug-induced-hyperuricemia-gout/

    I’ve not seen this as well presented elsewhere and the article is quite concise compared to many.
    Quite a few points echo what has been stated on Goutpal -often I see data that seems new and surprising and, later, I find it has been around for ages and just not filtering through.
    Goutpal seems to address this well as more and more sufferers are taking things into their own hands and refusing to be led around for ever.
    Just like politics lately… ;~/

  6. Has anyone any experience on the optimal time lapse between Lasix and Losartan?
    I gather the clearance time for Lasix (furosemide) is 6 hours would this then be the best time to follow with the Losartan or do they actually work together for lowering uric acid sometime in between taking simultaneously and the diuretic clearing some hours later?

    If this is such a useful protocol- and I hope it works for me, it’s possible half doses taken twice daily, with the requisite gap between them, could be doubly helpful too!
    Both tablets are ‘splittable’ , btw.

    • I was on Lasix 40mg and Losartan 50mg for years. I took both of them together in AM and Losartan 50mg at night. Last year my Uric acid level was 7.4 this year it was up at 9.0, Doctor prescribed me Medicine for Uric acid (Zolaric 100mg, 1-1). And put me on restricted diet. I ignored the doctors advise, searched the net and came accross this forum. I changed the time of my Lasix to 7.00 AM and rest of morning medicines at 10:30 AM. After 4 weeks my Uric acid level in blood has dropped to 5.9
      Thanks to every one who contributed.

      • It’s very encouraging to hear that. Something we often forget when uric acid is high – look for causes such as medications, and seek alternatives. This is common with the diuretic medications prescribed for high blood pressure, but can also include other medicines.

        I’m guessing the “Zolaric” is Zyloric – a brand of allopurinol. This would have helped, but removing the cause is much better. Diet restrictions, assuming this is the typical purine control, would have no effect on the diuretics, so would have been pointless (calorie restriction might help if planned carefully, but that is really a different issue).

        • I miss spelled, Zyloric was prescribed.
          I still do not know what to do next. Continue with my new timing of medicine (Lasix at 7.00 am and Rest of medince at 10:30AM) or any different time interval need to be used, once Uric Acid is control? There was no feedback from physician.

          • With uric acid at 5.9, you are just in the safe zone, so probably best to continue as you are. Unless you can find another doctor (who can give you better advice after a thorough examination of you and your medical history), the only other thing I can suggest is to buy your own uric acid monitor, and experiment with different BP medicine timings.

            • I beleive, I will have difficulty finding a physician, who has experience with this. If I continue the 3.5 Hours difference in dose timing, I may have to deal with ‘hypouricemia’ or will it cause high excretion of uric acid into the urine (hyperuricosuria)? In short is it safe to continue for longer period?

              • I cannot add further to my previous comments. I have no medical qualifications. The GoutPal websites exist to help you understand your physician’s advice, and know which questions to ask. You need to seek professionally qualified medical advice.

                • Since then, I have seen Cardiologist and he has reduce the dose of Lasix. My latest Uric Acid report did not register to him. I have no effect due to reduced dose of Lasix. I will see him in about ten days with some additional reports.

                  • Not sure what you mean by the uric acid report not registering.

                    Remember, uric acid monitoring is the responsibility of you and whoever is prescribing the allopurinol. 100mg is a usual “starter dose” to ensure you are tolerant. After that you adjust dose to get uric acid down to around 3 or 4 mg/dL for a few months. Once you have gone 6 months without a gout flare, dose can be relaxed a little, as long as you stay below 6.5 (better 6 to be safe).

  7. I take a diuretic for meniere’s disease and in the past few months I have seen small knots in my fingers and toes.

    • If these “knots” are uric acid deposits then it is unusual, but not impossible, for there to be no associated painful joint swelling. Best to get them checked out ASAP.

  8. uric acid control

    • malik says: uric acid control

      What does that mean?

      Are you seeking uric acid control, offering it, or advising it?

      Do you know something about uric acid and blood pressure medication that you can share with the rest of us?

      • trev said on July 8, 2009

        Zip- Is there an optimal time space between Lasix and Losartan? No one seems to know…
        Lasix has a 2Hr half life and Losartan half-life is 2 hours and its active metabolite half-life is 6 to 9 hours, reaching peak concentrations in l hour and 3-4 hours respectively.
        If this split time regime is good for SUA level lowering, then maybe a twice a day approach- on half doses of both could work?

  9. Very interesting study. I’m curious on the spacing of dosages? A few hours = 3?

  10. Lssix can have extended clearance time in the older patient,ehich I am.
    I generally stick to 5 to 6 hours gap if possible to allow max time of working but maybe 8 would be better.
    I also take Aliskiren [DRB] which knocks bask Lasix too,so for a trial took that every other day as it has a 40 hour clearance-but now will have to go back daily as this juggling with RAAS drugs is losing my BP control as I reduce Adrenal blockers also.
    It’s best to take Lasix first thing with a minimum of other meds ,I reckon.
    Higher levels than I’m taking are easily possible, if this is needed- but certainly check drug/drug and food /drug interactions on Drugs.com site -very useful. I’m sensitive to diuretics on the gout front!
    What a game it all is- but I’m determined to battle through!

  11. Not sure what the above comment refers to- but on the original post I have a personal update.
    Having taken the combo Lasix & Losartan for approx 8 weeks, I realised that though with the use of other drugs my BP had at last come down my Tinnitus was persisting.
    Loking at the US Drugs advice to users,I saw that tinnitus is listed as an immediate notifier to your prescriber rather than Hearing damage being a problem, usually reversible, in the UK version.
    Both these drugs are Ototoxic and can seriously affect hearing as the damage is at the single dose level >25mg /min in animal experiments with Furosemide (Lasix).
    I’ve suffered from Tinnitus for years but have no wish to lose my hearing due to drugs reactions. The list of such drugs is long and includes aspirin, which I was aware of.
    My Doc seems to think I want him to decide whether to continue or not, but this is not the case.
    I have reduced to a quarter dose by taking 20 mg Furosemide every other day with 25mg Losartan that day and going back to the gout inducing Thiazide 2.5 on the other day. This way I maintain the req’d water expulsion and hopefully minimise the ear risks and the gout also.
    These side effects are so utterly common- they should be called co-effects.
    I have compared the reported side effects on labels with internet reporting of the same drug and it oftens jumps from 5% reported effects in drug trials to 50% – 95% on-line, being what people really get!
    Anyone trying this drug therapy would be well advised to monitor the occurance and persistence of tinnitus closely.
    I’ll be interested to see what Zip has to say on his experiences.

  12. This is slightly different explanation as in the article:
    Hyperuricemia and Gout – New Insights into Pathogenesis and Treatment
    from:
    Bulletin of the NYU Hospital for Joint Diseases 2007;65(3):215-21

    Given these observations, the long-appreciated association
    between hyperuricemia and hypertension begins to take on
    an appearance of cause-and-effect. The question logically
    follows: might lowering serum urate provide a therapy for
    essential hypertension? Johnson’s group performed a small,
    open-label proof of principle study to test that hypothesis.
    They enrolled five adolescents with documented essential
    hypertension, all with serum urates of 6.0 mg/dL or above,
    in a 10-week trial. For the first 4 weeks, all of the patients
    received allopurinol, 200 mg BID. The remaining 6 weeks
    were a washout period. Blood pressure was measured before
    the administration of allopurinol, at the end of the four-week
    treatment course, and at the end of the washout period. After
    4 weeks of allopurinol therapy, all five patients demonstrated
    lowered blood pressure, with four of the five in the normal
    range. After the washout period, all five had significant
    increases of their blood pressures back toward their initial
    starting values.21 A larger blinded study is ongoing. These
    data suggest that urate can positively regulate human blood
    pressure, and that interventions to lower urate may be of
    value. Whether these results would apply to individuals with
    long-established hypertension or to people with “normal”
    serum urate values are questions that deserve answers.

  13. Whether these results would apply to individuals with long-established hypertension or to people with “normal” serum urate values are questions that deserve answers. :

    This article is exactly my response to this report, a while back.
    I have wondered the same, especially as young people will not have the negative co- factors that older people generally tend to have .
    The treatments for Hi BP are well known for only partial effectiveness (Ive seen 30% full success ‘back to normal’ mentioned) against this remarkably high result.
    Whether this effect can be sustained longterm is another matter.
    BP. meds. are notorious, also ,for losing their effectivness over time, and then being rested/restarted later- or switched to another type to maintain some relief from the BP going high or their side effects.
    My hopes are quite high on this work being followed up- but I still resist adding more meds to my armoury- Yet!

  14. My doctor just put me on Accuretic for hypertension and I am concerend whether it will cause falr-ups of gout? I have 2 attacks in 6 years and this concerns me as I have kept the gout at bay without any medications, ie Allipurinol or Colichine…Will Accuretic cause gout???

    • Accuretic is hydrochlorothiazide and quinapril. It commonly causes gout.

      You should go back to your doctor and discuss alternatives. Ask your doctor if the furosemide and losartan combination is suitable for you (taken separately with a few hours gap).

  15. Penny: You may want to take a look at a product called resperate. I recently bought one so I am still in the first couple months. Look it up and READ about it and make up your own mind. I would be glad to let you no how it works in another month or 2 if you would like. Tying to help not advertise GP.

    • Resperate is a paced breathing device. There are a couple of studies on it that show completely different results.

      “Device-Guided Breathing to Lower Blood Pressure: Case Report and Clinical Overview” by William J Elliot reports positive results, but “Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus: a randomized controlled trial.” reports no significant difference.

      The device is supposed to control your breathing to 10 breaths per minute, but according to the second study I mentioned, 40% of people did not achieve this.

      I would certainly try controlling my breathing without a device before spending money on one.

      The bigger issue, is whether controlled breathing will actually affect blood pressure. There are many causes of high blood pressure, and it would be irresponsible to try it without proper medical consultation.

  16. This info is very helpful as I have both Hi BP and gout. For years I took hydrochlorothiazide but not since the gout was discovered. It took several years to determine the bouts of toe pain were gout not bunion inflammation. I’m currently taking Diavan for BP. How does this drug effect gout?

    • Diovan is a brandname for valsartan. Valsartan works on blood pressure by blocking a hormone called angiotensin which causes blood vessels to constrict.

      There are many different types of angiotensin receptor blockers (ARBs). One of these, loasartan, is renowned for its uricosuric qualities – i.e. it encourages uric acid excretion which will lower uric acid in the blood for most people. However, as I revealed in losartan and gout, valsartan does not increase uric acid excretion. I should emphasize that this is a very complex area of medicine. The report I refer to is very technical, and may help doctors decide better treatments. The study reports that results are dosage-dependent, so different doses of different high blood pressure drugs may well have different effects on uric acid. This can become extremely complicated, but is made much simpler by a clear gout management plan.

      The only way to control gout is through controlling uric acid levels, and that must be the first priority for both you and you doctor. Allopurinol or other uric acid lowering treatment is usually the best way to acheive this, but it requires clear goals.

      Your lifetime objective is to maitain uric acid below 5mg/dL (0.30 mmol/L). If uric acid crystals have already built up in your joints – which is almost guaranteed – you need a few months at lower levels to get rid of the old crystals as quickly as possible. A target level of around 3mg/dL (0.20mmol/L) is good.

      For most gout patients, this should be easily acheivable, but if it is not, then your doctor can look at varying blood pressure medication to suit.

  17. my bro has been taking diuretics for high BP for almost 13 yrs. from last one yr he was having pain in the heels. blood reports showed slight elevated uric acid(7.4) dr prescribed some medicines…the pain has reduced but he got swelling in the calves & ankles..kindly advice

    thanks

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