Question

Which of the following antihypertensive drug is avoided in patients with high serum uric acid levels ?

• A. Hydrochlorothiazide
• B. Enalapril
• C. Prazosin
• D. Atenolol

Answer 1

The Correct Option is A

Side-effect recall: The classic metabolic adverse effects of thiazides are the 4 hyper-s plus hypos: hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, hypokalemia and hyponatremia.
Hyperuricemia is the key one here. Hydrochlorothiazide cuts urate excretion (competes for the tubular secretory pathway and causes volume contraction that boosts urate reabsorption), so blood uric acid climbs and gout can flare. That is why it is avoided when serum uric acid is high.
The alternatives are urate-neutral: enalapril (ACEi, even mildly uricosuric via losartan-like effects in some ARBs), prazosin (alpha-blocker), and atenolol (beta-blocker) do not raise uric acid. Any of these is preferable for a gouty hypertensive.
Pearl: gout plus hypertension, skip the thiazide; consider an ACE inhibitor or losartan.
Ref: K. D. Tripathi, 7th Edition, diuretics.