In conjunction with my reorganization of my Allopurinol And Other Medicines pages, I have moved an old forum message here.

Please join the discussion if you have any questions, opinions, or experiences of allopurinol with other medicines for high blood pressure.

The earlier discussion started with sputnik from UK asking:

After being diagnosed last year and having had three attacks of gout I bought a uric acid monitor and presented three months of tests to the Doctor today. (Average reading 8.9mg/dl).

I said that I would like to be treated with medication that reduced the amount of uric acid rather than with anti inflammatories that I consider only mask the real problem. My father was not treated properly for years and now has kidney disease that prevents him taking allopurinol etc.

The doc agreed to treat me but prescribed sulfinpyrazone rather than allopurinol as I am also taking 10mg Ramipril daily for high BP. Apparently there is a (low) risk of allopurinol causing reactions with ACE inhibitor medication. This seems to work differently to allopurinol by increasing excretion of UA rather than reducing its production.

I have a blood test booked next week to correlate my readings with a lab result and then start the sulfinpyrazone in gradually increasing doses until reading is within normal range. All these drugs carry the risk of side effects so does anyone have more information on what is the best treatment?

zip2play replied:

Sulfinpyrazone and probenecid are infrequently used because they generally cause MORE undesirable side effects than allopurinol. Is sulfinpyrazone available in the U.S.? I saw some conflicting info.
You are right, the chance of allopurinol side efffects are enhanced with an ACE inhibitor but only slightly and the causal evidence is scant. Your dosage of rampril is on the high side so maybe best to err on the side of caution.

I tried my hand at two of the ACE inhibitors, enalapril and captopril and both made me cough my head off?usually at the most incredibly inappropriate times: last straw was at the MET (Metropolitan Opera)?those around me were SO happy to listen to me hack before I got the good sense to go home and waste my $100 seat.)

So serendipity had me switch to losartan (Cozaar) an ARB which coincidentally is the only antihypertensive that is uricosuric?a good combo for gouty hypertensives.
If the sulfinpyrazone gives you a hard time consider allopurinol and losartan. Alas, it’s the weakest of the ARB’s and some of us must take it twice a day for much of an effect.
Let us know how the sulfinpyrazone treats you. Nobody else here has been on it?if my memory serves me.

The conversation fizzled out with other issues not related to high blood pressure.

I would like to generate some clear guidelines for using allopurinol if you also have treatment for high blood pressure. If we can reach consensus on the best approach, I will improve the guidelines on Allopurinol And Other Medicines.