American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medications are useful for managing patients with both hypertension and gout?

1. Beta-blockers

2. Angiotensin receptor blockers and calcium channel blockers

3. ACE inhibitors

4. Thiazide diuretics

The correct answer is: Angiotensin receptor blockers and calcium channel blockers

The choice of angiotensin receptor blockers (ARBs) and calcium channel blockers as effective medications for managing patients with both hypertension and gout is grounded in their pharmacological properties and their overall impact on uric acid levels. Angiotensin receptor blockers are known to have favorable effects on uric acid levels compared to other antihypertensive agents. They can help reduce the production of uric acid by influencing the renin-angiotensin system, making them suitable for patients with hypertension who are also struggling with gout. Similarly, calcium channel blockers are effective antihypertensive agents and do not elevate uric acid levels, thus providing a safe option for managing blood pressure in patients prone to gout flare-ups. In contrast, other medication classes present challenges in such dual management. For example, beta-blockers and ACE inhibitors are less favored in gout management due to their potential to cause increases in uric acid levels. Thiazide diuretics, while effective for hypertension, are known to increase uric acid levels and may exacerbate gout, making them a less desirable option for patients also dealing with this condition. In summary, the efficacy of ARBs and calcium channel blockers in controlling hypertension while not adversely affecting uric acid levels makes them particularly useful