2026 Eastern States Conference

Authors: Gi Eun (Jemma) Han, PharmD; Anthony M. Ishak, PharmD

Objective: Audience members will be able to assess the clinical relationship between losartan vs thiazide or thiazide-like diuretic use and gout/hyperuricemia incidence in patients who have hypertension.

Self-Assessment Question: How would the results of this study affect your decision with antihypertensive agent selection in patients with or at-risk for gout?

Background: Current gout guidelines preferentially recommend losartan for hypertension in individuals with gout for its suggested uricosuric effects. There are no real-world studies that directly compare losartan to thiazides and/or thiazide-like diuretics regarding their correlation to gout or hyperuricemia.

Methods: A total of 5,388 patients prescribed losartan or thiazide/thiazide-like diuretics (chlorthalidone, hydrochlorothiazide, indapamide, and metolazone) between July 1, 2023 and June 30, 2024 were identified from 11 primary care clinics in the Massachusetts General Hospital (MGH) system. The index event was defined as outpatient visits (including urgent care and emergency department) or hospitalization with a gout/hyperuricemia ICD-10 code as the primary or first diagnosis during the 1-year period. New outpatient prescriptions of colchicine, indomethacin, corticosteroids (i.e. prednisone, prednisolone, methylprednisolone, and triamcinolone acetonide injection), and uricosuric agents (i.e. allopurinol, febuxostat, probenecid) were also identified during the study period. Serum uric acid levels within 1 year prior to the index event were collected.

Results: Of the 2,591 patients taking losartan, 72 (2.8%) had visits related to gout/hyperuricemia. Of the 2,797 patients taking thiazides or thiazide-like diuretics, 77 (2.8%) had visits. There was no statistically significant difference between the two groups regarding the index event (p=0.954). Patients in the thiazide or thiazide-like diuretics group had a higher number of new prescriptions per patient than those in the losartan group for each type of medication. The mean serum uric acid level was lower in the losartan group compared to the thiazides and thiazide-related diuretics group (6.1 mg/dL [± 2.3 mg/dL] vs. 6.9 mg/dL [± 1.8 mg/dL]).

Conclusion: There was no statistically significant difference in gout/hyperuricemia occurrence for patients with hypertension taking losartan compared to those taking thiazides or thiazide-like diuretics during a 1-year study period.