Abstract
Objective: To assess the risk of new-onset gout following the use of hydrochlorothiazide (HCTZ) compared to chlorthalidone (CTD) for hypertension in adult patients. Methods: We used the PharMetrics Integrated Database to conduct this retrospective cohort analysis using administrative claims from 2000 to 2012. Patients age 18 to 89 years old with hypertension that were prescribed HCTZ or CTD were identified. Patients were included if they had a hypertension diagnosis (ICD-9 code 401.xx) prior to the first prescription for HCTZ or CTD as well as continuous medical and prescription benefit eligibility throughout the 36 month study period (24 months before and 12 months after first prescription). Patients were excluded if they had prior diagnosis of gout, heart failure, stage IVor V chronic kidney disease, conditions that increase serum uric acid, prescription claims for medications known to increase or decrease serum uric acid, or if they switched between HCTZ and CTD. Patients prescribed CTD were matched 1:2 with patients prescribed HCTZ based on age, sex and Chronic Condition Index. A database analysis was performed to evaluate the following outcomes: 1) new-onset gout using ICD-9 codes and/or prescription claims for gout-specific medications, 2) number of days of HCTZ or CTD therapy until occurrence of new-onset gout, and 3) median HCTZ or CTD dose. Bivariate descriptive statistics and a time-to-event analysis were used to evaluate these data. Results: A total of 1011 patients prescribed CTD met eligibility criteria and were matched 1:2 with 2022 patients prescribed HCTZ. Baseline characteristics were similar between groups; 1584 (52%) were female and the average age was 55 years. New-onset gout occurred in 17 of 1011 (1.68%) in the CTD group and in 26 of 2022 (1.29%) patients in the HCTZ group (p 1⁄4 0.27). The number of days to first occurrence of gout was 183.6 and 152.7 days in the CTD and HCTZ groups, respectively (p 1⁄4 0.39). The mean daily dose of the first prescription was 22.7 mg for CTD and 24.3 mg for HCTZ, and the median dose of both CTD and HCTZ was 25mg at the time of new-onset gout. Conclusion: Patients prescribed typical doses of CTD for hypertension have a similar risk of developing new-onset gout compared to patients prescribed similar doses of HCTZ. These results support more wide-spread use of CTD for the management of hypertension.
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