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The effects of the addition of losartan on uric acid metabolism in patients receiving indapamide
Spyros Nikas
Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
Evangellos Rizos
Department of Internal Medicine , Medical School, University of Ioannina, Ioannina, Greece
Haralampos Milionis
Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
Eleni Bairaktari
Department of Biochemistry Laboratory, Medical School, University of Ioannina, Ioannina, Greece
Rigas Kalaitzidis
Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
Kostas Siamopoulos
Department of Internal Medicine , Medical School, University of Ioannina, Ioannina, Greece
Moses Elisaf
Department of Internal Medicine , Medical School, University of Ioannina, Ioannina, Greece, melisaf@ cc.uoi.gr
Objective A number of adverse metabolic effects are associated with indapamide administration, including an increase in serum uric acid levels. It has been reported that losartan can significantly decrease serum uric acid levels. However, there are no data on the effects of combination therapy of losartan with indapamide on uric acid metabolism.
Methods We studied 20 hypertensive patients in whom serum metabolic parameters, including uric acid levels in serum and urine, were studied before and after eight weeks of indapamide administration (2.5 mg once daily) as well as eight weeks after combination treatment with indapamide (2.5 mg once daily) and losartan (50 mg/day).
Results Indapamide evoked a significant decrease in systolic and diastolic blood pressure from a mean value of 157±12 mmHg/96±10 mmHg to a mean value of 139±14 mmHg/92±5 mmHg (p<0.01 for both comparisons). However, a significant increase in serum uric acid levels was noticed after indapamide administration (from a mean value of 4.9±1.6 mg/dl to a mean value of 5.9±1.2 mg/dl, p<0.01), associated with a decrease in the fractional excretion of uric acid (from a mean value of 9±5% to a mean value of 7±5.5%, p<0.05). The addition of losartan caused a further decrease in blood pressure from a mean value of 139±14 mmHg/92±5 mmHg to a mean value of 120±15 mmHg/84±4 mmHg (p<0.01 for both comparisons). This was followed by a significant decrease in serum uric acid levels to 5±1.1 mg/dl (p<0.01) due to a substantial increase in fractional urate excretion (from 7±5.5 to 8.7±6%, p<0.05).
Conclusion The addition of losartan could offset the hyperuricaemic effect of indapamide administration.
Key Words: losartan • uric acid • uricosuria • hyperuricaemia
References
- Osei K., Holland G., Falko M. Indapamide. Effects on apoprotein, lipoprotein, and glucoregulation in ambulatory diabetic patients. Arch Intern Med 1986; 146: 1973-7.[Abstract/Free Full Text]
- Campell DB, Moore RA The pharmacology and clinical pharmacology of indapamide. Postgrad Med J 1981; 57(Suppl 2): 7-17.[Medline]
[Order article via Infotrieve]
- Elisaf MS, Theodorou J., Pappas H. et al. Effectiveness and metabolic effects of perindopril and diuretics combination in primary hypertension. J Hum Hypertens 1999; 13: 787-91.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Elisaf M., Tsimichodimos V., Bairaktari E. et al. Effect of micronized fenofibrate and losartan combination on uric acid metabolism in hypertensive patients with hyperuricemia. J Cardiovasc Pharmacol 1999; 34: 339-46.
- Nakashima M., Uematsu T., Kosuge K. et al. Pilot study of the uricosuric effect of DuP-753: a new angiotensin II receptor antagonist, in healthy subjects. Eur J Clin Pharmacol 1992; 42: 333-5.[Web of Science][Medline]
[Order article via Infotrieve]
- Flaherty JT, Edelman J., Kivlighn S. Effects of a low dose of thiazide diuretic on serum uric acid: Comparison of a losartan- based regimen vs usual care. (Abstract) 71st Scientific Session AHA. Circulation 1999:I-723.
- Soffer BA, Wright JT, Pratt JH et al. Effects of losartan on a background of hydrochlorothiazide in patients with hypertension. Hypertension 1995; 26: 112-7.[Abstract/Free Full Text]
- Grantham IJ, ChankoAM.The physiological basis and clinical uses of diuretics. In Brenner BM, Steind, eds. Sodium and water homeostasis. New York: Churchill Livingstone 1978: 178-211.
- Ruilope LM, Simpson RL, Toh J. et al. Controlled trial of losartan given concomitantly with different doses of hydrochlorothiazide in hypertensive patients. Blood Press 1996; 5: 32-40.[Medline]
[Order article via Infotrieve]
- Tsunoda K., Abe K., Hagino T. et al. Hypotensive effect of losartan, a nonpeptide angiotensin II receptor antagonist, in essential hypertension. Am J Hypertens 1993; 6: 28-32.[Web of Science][Medline]
[Order article via Infotrieve]
- Burnier M., Rutschmann B., Nussberger J. et al. Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects. Hypertension 1993; 22: 339-47.[Abstract/Free Full Text]
- Grossman E., Peleg E., Carroll J. et al. Hemodynamic and humoral effects of the angiotensin II antagonist losartan in essential hypertension. Am J Hypertens 1994; 7: 1041-4.[Web of Science][Medline]
[Order article via Infotrieve]
- Edwards RM, Trizna W., Stack EJ et al. Interaction of nonpeptide angiotensin II receptor with the urate transporter in rat renal brush-border membranes. J Pharmacol Exp Ther 1996; 276: 125-9.[Abstract/Free Full Text]
- Burnier M., Roch-Ramel F., Brunner HR Renal effects of angiotensin II receptor blockade in normotensive subjects. Kidney Int 1996; 49: 1787-90.[Web of Science][Medline]
[Order article via Infotrieve]
- Burnier M., Brunner HR Angiotensin II receptor antagonists. Lancet 2000; 355: 637-45.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Shahinfar S., Simpson RL, Carides AD et al. Safety of losartan in hypertensive patients with thiazide-induced hyperuricemia. Kidney Int 1999; 56: 1879-85.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Cogan MG, Xie MH, Lin FX, Wong P., Timmermans PB Effect of DuP 753 on proximal nephron and renal transport. Am J Hypertens 1991; 4:315S-3120S.[Medline]
[Order article via Infotrieve]
Journal of Renin-Angiotensin-Aldosterone System, Vol. 1, No. 3,
289-291 (2000)
DOI: 10.3317/jraas.2000.045
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