The Effects of Antihypertensive Class on Gout in Older Adults: Secondary Analysis of the ALLHAT Trial
Abstract
Objectives: Gout is a common complication of blood pressure management and a frequently cited cause of medication non-adherence. 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% (HR 0.63; 95% CI: 0.51,0.78) compared with chlorthalidone and by 26% (HR 0.74; 95% CI: 0.58,0.94) compared with lisinopril. Lisinopril non-significantly lowered gout risk compared with chlorthalidone (HR 0.85; 95% CI: 0.70,1.03). Atenolol use was not associated with gout risk (adjusted HR 1.18; 95% CI: 0.78,1.80). Gout risk reduction was primarily observed after 1 year of…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 23,964 participants or records.
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