| Title: | Urate-lowering effects of losartan: a meta-analysis of randomised controlled trials and target trial emulation |
| Journal: | Hypertension Research |
| Published: | 15 Jul 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/42458015/ |
| DOI: | https://doi.org/10.1038/s41440-026-02719-0 |
| URL: | https://www.nature.com/articles/s41440-026-02719-0.pdf |
Publication 20275
WARNING: the interactive features of this website use CSS3, which your browser does not support. To use the full features of this website, please update your browser.
Abstract
Common in hypertensive patients, hyperuricaemia is often exacerbated by guideline-recommended antihypertensive therapies such as thiazide diuretics. Losartan is known as an angiotensin II receptor type 1 antagonist with a uricosuric effect, but the magnitude of its efficacy in lowering urate has not been quantified versus a placebo-reference. We sought to quantify the urate-lowering effect of losartan versus placebo using two complementary approaches. We first conducted a meta-analysis of randomised controlled trials (RCTs) to quantify the effect of losartan on serum urate levels versus placebo. We then applied a target trial emulation framework in the UK Biobank as a secondary source of data and a replication experiment. The meta-analysis of six prospective randomised controlled trials (RCTs), including 1119 losartan-treated patients and 1093 controls, demonstrated that losartan reduced serum urate levels by approximately 0.29 mg/dL relative to placebo (95% CI: −0.46 to −0.12, p = 0.0009). In the target trial emulation, 23 losartan-treated individuals showed a reduction in serum urate of approximately 0.35 mg/dL (95% CI: −0.66 to −0.03, p = 0.03) when compared with 92 matched controls, and after accounting for 12 potential confounders including established urate-lowering therapies. Our results provide evidence for a modest yet consistent urate-lowering potential of losartan. This modest biochemical effect (~0.3 mg/dL) may be an attractive option to mitigate the diuretic-induced urate elevation. Thus, losartan can be considered as a favourable antihypertensive choice for patients managed with diuretics or those who are at risk of hyperuricaemia/gout.</p>
8 Authors
- Xiaoguang Xu
- Ahlam Naeem
- Amber Emmett
- Mateusz Siedlinski
- Hector Chinoy
- Tomasz J. Guzik
- Evangelos Kontopantelis
- Maciej Tomaszewski
Enabling scientific discoveries that improve human health