The angiotensin receptor blocker (ARB) losartan is the most appropriate antihypertensive drug for this patient with hyperuricemia who is at increased risk for acute gout. Hypertension is a common comorbidity of gout and is found in approximately 74% of patients with gout. Antihypertensive drugs have variable effects on serum urate levels and risk of acute gout. A population-based, nested-case control study compared nearly 25,000 patients with a new diagnosis of gout with 50,000 control patients. The risk of gout was assessed according to antihypertensive drug class. Losartan, but not other ARBs, and calcium channel blockers were associated with a reduced risk of gout (relative risk for losartan: 0.81 [95% CI, 0.7-0.84]; relative risk for calcium channel blockers: 0.87 [95% CI, 0.82-0.93]). Both losartan and calcium channel blockers lower serum urate. Losartan, like probenecid, interferes with the urate-reabsorbing transporter, thereby promoting kidney urate excretion. The mechanism by which calcium channel blockers lower urate levels is unclear but may be mediated through increased glomerular filtration rate and increased urate clearance. Based upon these data, losartan and calcium channel blockers are the preferred antihypertensive agents if reducing the risk of gout is clinically relevant.

In this same study, ACE inhibitors, non-losartan ARBs, β-blockers, and diuretics were all associated with an increased risk of gout. The absolute risk of gout was greatest with diuretics, with an estimated risk of six events per 1000 person-years.