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Losartan Uricosuric Property — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyLosartan Uricosuric PropertySCE Rheumatology

A 55-year-old man with gout and heart failure (NYHA II) on Furosemide asks whether Losartan would help his gout. His GP is considering an ARB for his hypertension. What unique property does Losartan have?

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Correct answer: A — Losartan has a specific uricosuric effect (not shared by other ARBs to the same degree) reducing serum urate by 20-25% through inhibition of URAT1 transporter making it the preferred antihypertensive in patients with coexisting gout

Losartan uniquely among commonly used ARBs has a clinically meaningful uricosuric effect reducing serum urate by approximately 20-25% through inhibition of the URAT1 urate transporter in the proximal tubule. This property is specific to Losartan and is NOT shared to the same degree by other ARBs (Valsartan Candesartan Irbesartan). BSR 2017 gout guidelines recommend considering Losartan as the preferred antihypertensive in patients with coexisting gout and hypertension. Switching from a thiazide diuretic to Losartan can simultaneously improve blood pressure control and reduce hyperuricaemia.

Reference: BSR 2017 gout guidelines; Wurzner G et al 2001 Losartan uricosuric effect