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Gout and diuretics — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesGout and diureticsSCE Rheumatology

A 60-year-old man with recurrent gout takes bendroflumethiazide for hypertension. Serum urate is 540 micromol/L. He has no heart failure and renal function is normal. Blood pressure is 138/82 mmHg. He is starting urate-lowering therapy. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Review thiazide and consider an alternative antihypertensive

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

Review thiazide and consider an alternative antihypertensive is best because thiazide diuretics can worsen hyperuricaemia and should be reviewed when managing recurrent gout. A is less suitable because stopping all antihypertensives is unsafe; B is less suitable because loop diuretics can also raise urate and are not urate-lowering drugs; D is less suitable because drug contributors are a modifiable part of gout care; E is less suitable because increasing thiazide may worsen gout. Clinical pearl: losartan is often considered when an antihypertensive with urate-lowering tendency is suitable.

Reference: NICE NG219; BNF