Dr. Kumar’s Take:
This study highlights something unique about losartan compared to other blood pressure medicines. Losartan not only lowers blood pressure, it also lowers uric acid by blocking a kidney transporter called URAT1. For patients with both hypertension and gout risk, this dual effect is an important advantage.
Key Takeaways:
✔ Losartan lowered uric acid levels while reducing blood pressure.
✔ The effect is linked to blocking the kidney transporter URAT1.
✔ Candesartan, another blood pressure drug, lowered blood pressure but had no effect on uric acid.
✔ Patients with defective URAT1 genes did not benefit from losartan’s uric acid effect.
Actionable Tip:
If you have both high blood pressure and a history of gout, ask your doctor if losartan might be a better choice compared to other ARBs, since it can help with both conditions.
Brief Summary:
This clinical trial examined whether losartan’s uric acid-lowering effect was truly due to URAT1 inhibition in humans. Researchers studied 32 hypertensive patients treated with either losartan or candesartan for one month. They also compared results in patients with genetic mutations in URAT1.
Losartan lowered uric acid levels and increased uric acid clearance in patients with normal URAT1 genes, but not in those with loss-of-function mutations. Candesartan had no effect on uric acid.
Study Design:
- Participants: 32 hypertensive patients (16 received losartan 50 mg/day, 16 received candesartan 8 mg/day) and 9 patients with idiopathic renal hypouricemia.
- Measurements: Serum uric acid, creatinine, and clearance ratios (Cur/Ccr) before and after 1 month of treatment.
- Genetic factor: URAT1 mutations were assessed to see if they influenced losartan’s uricosuric action.
- Comparison: Benzbromarone, a known URAT1 inhibitor, was used as a reference.
Results:
- Losartan: Lowered uric acid and increased uric acid clearance.
- Candesartan: Lowered blood pressure but did not change uric acid.
- Patients with URAT1 mutations: Neither losartan nor benzbromarone affected uric acid levels.
- Patients with normal URAT1: Both losartan and benzbromarone increased uric acid clearance.
How Losartan Lowers Uric Acid:
Losartan blocks URAT1, a transporter in the kidneys that normally reabsorbs uric acid back into the bloodstream. By inhibiting URAT1, losartan promotes uric acid excretion in the urine, lowering serum uric acid levels. This action makes losartan unique among blood pressure medications.
Related Studies and Research
Vitamin C, Coffee, and Milk: Gout Risk Study – Investigates how common dietary elements influence uric acid levels and gout risk.
Uric Acid and Human Evolution – Reviews the evolutionary loss of uricase and its ties to blood pressure and metabolism.
The Glorification of Gout in Literature – Explores how gout was historically portrayed as a disease of status and intellect.
Podcast: How to Make Gout Disappear from Your Life – A comprehensive look at modern and ancient gout science—and how to beat it.
Frequently Asked Questions
Does losartan prevent gout?
Losartan can reduce uric acid, which lowers gout risk, but it is not a first-line gout medication. Its effect is modest compared to drugs designed specifically to treat gout.
Is losartan better than other blood pressure drugs for people with gout?
Yes. Unlike other ARBs or ACE inhibitors, losartan has an added benefit of lowering uric acid.
Can everyone benefit from losartan’s uric acid effect?
No. Patients with certain URAT1 genetic mutations do not experience this benefit.
Are there side effects?
Losartan is generally well-tolerated, with a safety profile similar to other ARBs. The study did not report new risks related to uric acid lowering.
Conclusion
Losartan is a rare blood pressure medication that doubles as a uric acid–lowering drug by blocking URAT1. For patients with both hypertension and gout, this dual action makes losartan a strategic choice. Its role should be considered when selecting therapy, especially in individuals at risk for gout.