DASH Diet and Losartan control uric acid and BP in patients with Hypertension and Gout

In the relentless battle against hypertension and the looming threat of gout, a groundbreaking study has illuminated a path forward. The findings from a post-hoc analysis of the DASH-losartan trial promise hope by shedding light on the potential of two well-known interventions— the DASH diet and losartan—in not only lowering blood pressure but also mitigating the risk factors associated with hypertension and gout. 

The trial results were published in the Journal of Clinical Hypertension on August 21, 2023. 

Hypertension is a widespread health concern with serious implications for heart health. It's not alone in the spotlight; lurking in its shadows is gout, a painful condition caused by the buildup of uric acid crystals in the joints. Recent research suggests that serum urate levels are not only linked to gout but also play a role in hypertension. The DASH diet, renowned for its ability to reduce high blood pressure through dietary modifications and Losartan, a medication commonly prescribed for hypertension, also joins the stage as a formidable contender. Both interventions have shown independent prowess in managing blood pressure, but the study seeks to unravel their potential in addressing serum urate levels, a lesser-known but critical aspect of hypertension and gout. 

The study enrolled 55 participants, their average age being 52 years, comprising 58% women and 64% Black individuals— a diverse cohort reflecting the real-world prevalence of these conditions. Post-hoc analysis of the DASH-losartan trial was carried out with DASH diet or a standard American diet (control) and in crossover fashion to 4-week losartan or placebo. Serum urate was measured at baseline and after each 4-week period. Diets were designed to maintain weight constant. At the outset, participants exhibited a mean baseline ambulatory systolic blood pressure (SBP) of 146 mm Hg and diastolic blood pressure (DBP) of 91 mm Hg. Their average serum urate level at the start was 5.2 mg/dL. 

Findings: 

• The DASH diet did not demonstrate a significant reduction in serum urate levels across the entire participant group. 
• But it showed remarkable promise among those grappling with baseline hyperuricemia where participants experienced a notable drop in serum urate levels, suggesting the DASH diet's potential to address hyperuricemia and potentially reduce the risk of gout. 
• Losartan led to a significant reduction in serum urate levels overall, indicating its potential to combat gout risk.
• Notably, the effects of losartan were more pronounced among younger adults, those below the age of 60, compared to their older counterparts.
• This age-based interaction suggests that losartan could be particularly beneficial for younger individuals dealing with elevated uric acid levels.

Thus, the present trial emphasizes the potential of the DASH diet to reduce serum urate levels in individuals already at risk due to hyperuricemia. Moreover, losartan's ability to lower serum urate levels, especially among younger adults, hints at its multifaceted benefits beyond hypertension management. These discoveries could pave the way for more tailored approaches to managing both conditions. Future research will likely delve deeper into the effects of these interventions on patients with hyperuricemia or diagnosed gout, potentially revolutionizing the way these conditions are approached in clinical settings. 

Further reading: Castilla-Ojo N, Turkson-Ocran RA, Conlin PR, Appel LJ, Miller ER 3rd, Juraschek SP. Effects of the DASH diet and losartan on serum urate among adults with hypertension: Results of a randomized trial [published online ahead of print, 2023 Sep 11]. J Clin Hypertens (Greenwich). 2023;10.1111/jch.14721. doi:10.1111/jch.14721