Effect of hydrochlorothiazide and indapamide on renal handling of uric acid in patients with essential hypertension

Andrzej Tykarski, Anna Posadzy-Małaczyńska, Paweł Łopatka, Jerzy Głuszek, Danuta Musialik, Bożena Raszeja-Wanic


Background High serum uric acid is a frequent finding in patients
with essential hypertension, It is partly caused by antihypertensive
therapy. Thiazides diminish renal excretion of uric acid and increase
the incidence of hyperuricemia. Indapamide, thiazide-like diuretic
has diiferent metabolic profile but little is known about its effect on
uric acid excretion.
The aim of the study was to compare the effect of hydrochlorothiazide and indapamide on plasma uric acid and tubular transport
of urate in nephron in hypertensive patients.

Methods Thirty six patients with mild to moderate essential hypertension were studied. Twenty of them received hydrochlorothiazide
in dose 25 mg/day and sixteen were treated with indapamide in
dose 2,5 mg/day as monotherapy. Patients were kept on normal
sodium and purine diet. Plasma uric acid (Pua) was measured and
pharmacological tests with pirazynamide and benzbromarone were
performed before and after 3 to 5 weeks of diuretic treatment. Based
on these tests uric acid clearance and fractional excretion as well as
presecretory reabsorption, tubular secretion and postsecretory reabsorption of uric acid were calculated.

Results and conclusions Hydrochlorothiazide increases plasma
uric acid and decreases its renal excretion in hypertensive patients.
Both diminished tubular secretion and accelerated postsecretory reabsorption of uric acid are responsible for hypcruricaemic action of
hydrochlorothiazide. Indapamide does not change neither plasma
uric acid nor its renal handling. It seems that in patients with essential hypertension and gout indapamide is the diuretic of choice.


essential hypertension; uric acid; hydrochlorothiazide; indapamide

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl