Comparison of the Effect of Angiotensin II Type I Receptor Blockers on Serum Uric Acid in Hypertensive Patients in Mosul City

Research Article

Austin Hypertens. 2022; 3(1): 1013.

Comparison of the Effect of Angiotensin II Type I Receptor Blockers on Serum Uric Acid in Hypertensive Patients in Mosul City

Dawood KH¹*, Saeed AA² and Khudhur GA³

¹Diploma of Family Medicine, Al-Quds Health Center, Mosul, Iraq

²F.I.C.MS Path, Nineva Rehabilitation Center, Mosul, Iraq

³Diploma of Family Medicine, Al-Quds Health Center, Mosul, Iraq

*Corresponding author: Kasim Hazim Dawood, Diploma of Family Medicine, Al-Quds Health Center, Mosul, Iraq

Received: July 18, 2022; Accepted: August 16, 2022; Published: August 23, 2022

Abstract

Background: Angiotensin II type I Receptor Blockers (ARB) are a frequently used class of antihypertensive drugs. The ARB losartan is known to decrease the serum uric acid (SUA) level. However, there are very few clinical data comparing the effects of other ARBs on SUA level under the conditions of clinical practice. This study evaluated and compared the long-term effects of monotherapy with five ARBs on SUA level in hypertensive patients in Mosul city.

Methods: We identified hypertensive patients who had been treated with monotherapy with losartan (n = 30), valsartan (n = 32), telmisartan (n = 29), candesartan (n = 31), or irbemesartan (n = 28), in whom laboratory data of SUA between December 1 2019 and February 1 2021 were available and compared the SUA level. The mean exposure of losartan was 245 days, valsartan 240 days, telmisartan 238 days, candesartan 242 days, and irbesartan 239 days.

Results: In losartan users, mean SUA level was significantly decreased from baseline, while it was conversely increased in users of other ARBs; valsartan, telmisartan, candesartan, and irbemesartan. The mean reduction of SUA level from baseline was significantly greater in losartan users compared with that in other ARB users. Comparison of ARBs other than losartan showed no significant difference in mean change in SUA level from baseline.

Conclusions: Our study showed that losartan had the most beneficial effect on SUA level among five ARBs, and that there was no significant difference in the unfavorable effects on SUA level among four ARBs other than losartan, at least during one year. These findings provide evidence of an effect of ARBs on SUA level.

Keywords: ARB monotherapy; Losartan; Valsartan; Telmisartan; Candesartan; Irbesartan; Serum Uric Acid; Hypertension

Abbreviations

ARB: Angiotensin type II Receptor Blocker; CCB: Calcium Channel Blockers; NSAID: Non-Steroidal Anti- Inflammatory Drug; SUA: Serum Uric Acid; URAT1: Urate Transporter 1

Introduction

The main cause of gout is high concentration of serum uric acid (SUA), and is also associated with the metabolic syndrome, including hypertension [1-4]. In the report of the US National Health and Nutrition Examination Survey, among patients with gout, 74% had hypertension [5]. Many patients with hyperuricemia are using antihypertensive agents because hypertension and hyperuricemia are conditions that frequently coexist. Antihypertensive drugs have different effects on uric acid. Beta blockers and thiazide diuretics increase the SUA level whereas alpha-blockers and Calcium-Channel Blockers (CCB) decrease the SUA level [6-8]. The effect of Angiotensin II type I Receptor Blockers (ARBs) on the SUA level differs among drugs. Of ARBs, losartan decreases the SUA level [9-17] via its influence on Urate Transporter 1 (URAT1) [18-20]. Differing from losartan, valsartan and candesartan have been reported to increase the SUA level in patients with hypertension [21,22]. Several studies have compared the effect of losartan on SUA with that of another drug or placebo. Few studies have performed a multiple comparison of the effects on SUA level among various ARBs in clinical practice. The aim of this study was to evaluate and compare the long-term effect of five ARB monotherapies; losartan, valsartan, candesartan, telmisartan, and irbesartan, on SUA in hypertensive patients in Mosul city.

Study Populations

We identified patients with mild to moderate hypertension aged over 20 years, who had been newly treated with ARB monotherapy for at least two months between December 1, 2019 and February 1, 2021. The five ARBs used in this study were losartan potassium, valsartan, telmisartan, candesartan cilexetil, and irbesartan (Table 1). The numbers of monotherapy patients in this study were; losartan (n = 30), valsartan (n = 32), telmisartan (n = 29), candesartan (n = 31), and irbesartan (n = 28) (Table 2). The experimental protocol was approved by the Ethical Committee of Al-Quds health center and was conducted in compliance with the ethical guidelines for epidemiological research of the Ministry of Health Iraq.