Paciente com Hipertensão Arterial Sistêmica (HAS) em tratam...
The rise in serum urate with the most common diuretic used to treat hypertension, hydrochlorothiazide, is relatively small at low doses (figure 1) and can be minimized by concurrent therapy with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB). In addition, the ARB losartan reduces serum urate via a modest uricosuric effect that appears to plateau at a dose of 50 mg/day and is not seen or is less pronounced with other ARBs and with ACE inhibitors [55]. Gout patients who need an antihypertensive agent may thus also benefit from the uricosuric effect of losartan and avoid the need for further xanthine oxidase inhibitor (XOI) dose escalation or use of an alternative uricosuric drug to lower urate concentrations. (See "Use of thiazide diuretics in patients with primary (essential) hypertension" and "Diuretic-induced hyperuricemia and gout", section on 'Benefits of angiotensin inhibition and losartan'.)
Other nondiuretic antihypertensives may also affect urate levels and the risk of gout. Beta-blockers have been reported to increase serum urate [56,57] and the risk of incident gout [58], while calcium-channel blockers have been found to decrease both urate levels [59,60] and incident gout risk [58].
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Pegadinha. Candidato precipitado a todo custo marcaria o item Hidroclorotiazida, mas diuréticos, iECA e BRA não Losartano elevam ácido úrico.
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