The effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on serum uric acid levels in adult patients with arterial hypertension: A systematic review

Aim. To summarize the available data on the effects of first-line antihypertensive agents – angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) – on serum uric acid (UA) levels in adults with (arterial hypertension) AH, with the goal of optimizing pharmacotherapy in patients with AH and asymptomatic hyperuricemia.

Material and methods. A comprehensive search was conducted in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) within the Cochrane Library, eLIBRARY, Google Scholar, and the National Institutes of Health clinical trials registry ClinicalTrials.gov. The systematic review was prepared in accordance with PRISMA guidelines. No restrictions were placed on the year of publication during the search and analysis.

Results. Analysis of nine randomized controlled trials of ACEIs showed that enalapril, captopril, and fosinopril demonstrated neutrality with respect to UA levels, whereas other drugs in this class may increase UA concentrations. Analysis of eleven randomized controlled trials of ARBs showed that only losartan exhibits a uricosuric effect, while irbesartan, valsartan, and eprosartan are metabolically neutral.

Conclusion. Among ACEIs, enalapril, low-dose ramipril, and fosinopril exhibit the most favorable safety profile and the greatest neutrality regarding UA levels. ARBs are generally metabolically neutral with respect to UA, with the exception of losartan, which possesses a uricosuric effect.

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