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Diuretic use, increased serum urate levels, and risk of incident gout in a population‐based study of adults with hypertension: The Atherosclerosis Risk in Communities ...

MA Mc Adams De Marco, JW Maynard... - Arthritis & ..., 2012 - Wiley Online Library Objective To quantify the role of diuretic use in gout development in an adult population with hypertension. Methods The Atherosclerosis Risk in Communities study, a prospective population-based cohort from 4 US communities, consisted of 4 visits over a 9-year period ...

Epidemiologic studies have suggested that a history of diuretic use is associated with gout (7, 10, 11). For example, in a community based cohort of white adults, the history of any diuretic use was associated with a 2.4 fold increased risk of gout in women and a 3.4 fold increased risk in men after adjustment for hypertension and other gout risk factors (11). The results may be biased away from the null due to confounding by indication, because this cohort was relatively healthy and diuretic use may be a marker of worse health. In contrast, a pharmacoepidemiologic case control study using records from a single Dutch primary care center showed that the association between being prescribed a diuretic and a diagnosis of gout was null after adjustment for history of hypertension and other confounders (12). Our results may differ from those of the Dutch case control study because of the control selection used in that study; matching on comorbid conditions rather than adjusting for those conditions will allow for a more accurate comparison in which both the case and the control are likely to be exposed to a diuretic. By restricting our study to participants with hypertension and adjusting for time varying blood pressure, we were better able to control for confounding by indication. However, our results were similar to those of a community based cohort study showing that diuretic use was associated with the development of gout in men (HR 1.77 [95% CI 1.42, 2.20]) (10).