Valsartan and Gout: What This Blood Pressure Drug Does to Your Uric Acid

Valsartan and Gout: What This Blood Pressure Drug Does to Your Uric Acid

If you have gout and high blood pressure, your medication choices matter more than you might think. Valsartan is one of the most commonly prescribed blood pressure drugs in the United States, sold under the brand name Diovan and available as a generic. It belongs to a class of medications called angiotensin II receptor blockers (ARBs). But not all ARBs affect uric acid the same way, and if you are dealing with gout, that difference can mean the difference between stable joints and a painful flare.

This article breaks down what valsartan does to uric acid levels, how it compares to other ARBs (especially losartan), and what the research says about using valsartan when you also manage gout.

How Valsartan Works

Valsartan blocks the action of angiotensin II, a hormone that narrows blood vessels and raises blood pressure. By blocking this hormone, valsartan relaxes blood vessels, lowers blood pressure, and reduces the workload on the heart. The FDA has approved valsartan for treating high blood pressure (hypertension), heart failure, and for improving survival after a heart attack.

Many people with gout also have hypertension. In fact, research suggests that up to 74% of people with gout also have high blood pressure. This overlap means that the choice of antihypertensive medication can directly affect gout management.

Valsartan’s Effect on Uric Acid: The Short Answer

Here is what the evidence shows: valsartan does not lower uric acid. Multiple studies have found that valsartan has either a neutral effect on serum uric acid (SUA) or may even slightly raise it.

The FDA label for valsartan states that in multiple-dose studies of hypertensive individuals, valsartan had “no notable effects on total cholesterol, fasting triglycerides, fasting serum glucose, or uric acid.” In other words, valsartan appears to be uric-acid-neutral based on the manufacturer’s own data.

However, a large retrospective observational study from Japan tells a slightly different story. Researchers compared five ARBs (losartan, valsartan, telmisartan, candesartan, and olmesartan) in 1,315 hypertensive individuals with type 2 diabetes. After adjusting for baseline differences, they found that SUA levels actually increased with valsartan (from 5.30 mg/dL to 5.49 mg/dL, p = 0.0012). The same trend appeared with telmisartan, candesartan, and olmesartan. Only losartan lowered SUA.

Why Losartan Is Different

The reason losartan lowers uric acid while valsartan does not comes down to a single molecular target: URAT1.

URAT1 (urate transporter 1) is a protein in the kidneys that reabsorbs uric acid from urine back into the bloodstream. When URAT1 is blocked, more uric acid stays in the urine and gets excreted, lowering blood uric acid levels.

An in vitro study by Iwanaga and colleagues used URAT1-expressing cells to test several ARBs. They found that losartan, telmisartan, and pratosartan inhibited URAT1-mediated uric acid uptake. Valsartan, candesartan, and olmesartan did not.

This is why the 2020 American College of Rheumatology (ACR) gout treatment guideline conditionally recommends “choosing losartan preferentially as an antihypertensive agent for people with gout.” Losartan is the only ARB with consistent clinical evidence of uric acid lowering, and it is the only ARB mentioned in the ACR guideline for gout management.

What the Clinical Studies Show

A 2019 review by Sutton Burke examined whether uric acid lowering is a “class effect” of ARBs, meaning all ARBs would share this benefit. After evaluating eight studies, the review concluded that the reduction of serum uric acid is NOT a class effect of ARBs. Of all available ARBs, only losartan showed clear evidence of lowering uric acid.

The Dang et al. Trial

One randomized controlled trial by Dang and colleagues enrolled 351 hypertensive individuals with asymptomatic hyperuricemia. After 8 weeks of treatment:

• Losartan reduced SUA from 7.09 mg/dL to 6.04 mg/dL (a drop of 1.05 mg/dL, p < 0.0001)
• Irbesartan reduced SUA from 7.04 mg/dL to 6.86 mg/dL (a drop of only 0.18 mg/dL, p < 0.05)

Valsartan was not included in this trial, but other studies have shown similar patterns: valsartan either has no effect or slightly raises SUA.

The Choi et al. Case-Control Study

A large case-control study by Choi and colleagues compared gout incidence among people taking losartan, other ARBs (including valsartan), and other antihypertensive medications. The study included 24,768 gout cases and 50,000 controls. They found:

• Losartan was associated with a lower risk of gout (relative risk 0.81)
• Other ARBs were associated with a higher risk of gout (relative risk 1.29)

This does not prove that valsartan causes gout. But it does suggest that regarding gout risk, not all ARBs are created equal.

Valsartan vs. Losartan: A Head-to-Head

Feature	Valsartan	Losartan
Lowers uric acid	No	Yes
URAT1 inhibition	No	Yes
ACR gout guideline recommendation	No	Yes
FDA-approved for heart failure	Yes	No
FDA-approved for post-MI	Yes	No
FDA-approved for diabetic nephropathy	No	Yes

If you have gout and hypertension without heart failure, losartan is generally the preferred ARB. But if you have heart failure or have recently had a heart attack, valsartan may be the more appropriate choice for your cardiovascular health, even though it will not help your uric acid.

This is where shared decision-making with your doctor comes in. If you need valsartan for heart failure, you can still manage your gout with dedicated urate-lowering therapy such as allopurinol or febuxostat. Valsartan will not interfere with these medications.

What If You Are Already Taking Valsartan?

If you are currently on valsartan and also managing gout, here are a few things to keep in mind:

1. Monitor your uric acid regularly. Valsartan is unlikely to lower your uric acid, so you will need dedicated urate-lowering therapy if your levels are high. The target for most people with gout is a serum uric acid below 6 mg/dL.

2. Do not stop valsartan on your own. If valsartan was prescribed for heart failure or post-heart attack care, stopping it abruptly could be dangerous. Talk to your doctor before making any changes.

3. Ask about combination therapy. Many people take valsartan for cardiovascular protection alongside allopurinol or febuxostat for uric acid control. This is a common and effective approach.

4. Watch for drug interactions. Valsartan can raise potassium levels. If you are also taking potassium-sparing diuretics or potassium supplements, your doctor should monitor your blood work.

For more on how blood pressure medications can affect gout, see our article on Your Blood Pressure Pill Might Be Behind Your Gout.

Other ARBs and Gout

Beyond valsartan and losartan, here is how other ARBs stack up:

• Irbesartan: Shows a neutral to very mild uric acid lowering effect. One study found a small reduction (0.18 mg/dL), but it was not clinically significant compared to losartan.
• Candesartan: Appears neutral or slightly negative on uric acid. A study by Rayner et al. found SUA actually increased by 0.33 mg/dL with candesartan, while it dropped 0.84 mg/dL with losartan.
• Telmisartan: In laboratory studies, telmisartan showed URAT1 inhibition, but clinical data has not confirmed a meaningful uric acid lowering effect in humans.
• Olmesartan: May raise uric acid. Some sources recommend avoiding olmesartan in people with gout.

The bottom line: among all ARBs, losartan stands alone as the one with consistent clinical evidence for lowering uric acid.

Valsartan and Gout Flares

Will taking valsartan trigger a gout flare? There is no direct evidence that valsartan causes gout attacks. The concern is more about what valsartan does NOT do: it does not provide the uric acid lowering benefit that losartan does.

If your uric acid is already well-controlled with medication like allopurinol, taking valsartan for your blood pressure or heart condition should not pose a problem. The issue arises when someone switches from losartan to valsartan (or starts valsartan instead of losartan) without addressing the lost uric acid benefit.

If you have experienced a gout flare after a medication change, our article on Why Your Gout Pain Lingers Even When Uric Acid Looks Normal explains why symptoms can persist even when lab numbers look fine.

Practical Takeaways

• Valsartan is a safe and effective blood pressure medication, but it does not lower uric acid.
• If you have gout and need a blood pressure medication, ask your doctor if losartan is appropriate for you.
• If you need valsartan for heart failure or post-heart attack care, you can still manage gout effectively with separate urate-lowering therapy.
• The 2020 ACR guideline recommends losartan as the preferred ARB for people with gout.
• Do not stop or switch medications without consulting your healthcare provider.

For people dealing with both gout and kidney concerns (a common overlap since the kidneys handle uric acid excretion), our article on Gout and Kidney Stones: The Hidden Connection covers how these conditions interact.

Frequently Asked Questions

Can valsartan cause gout?

No direct evidence shows that valsartan causes gout. However, valsartan does not lower uric acid the way losartan does. If you switch from losartan to valsartan without adjusting your gout treatment, your uric acid may rise, which could increase flare risk over time.

Is valsartan safe for people with gout?

Yes, valsartan is generally safe for people with gout. It will not lower your uric acid, but it will not dangerously raise it either. If you need valsartan for heart failure or post-heart attack care, the cardiovascular benefits typically outweigh the lack of uric acid benefit. Just make sure your gout is managed separately with appropriate urate-lowering therapy.

Which blood pressure medication is recommended for gout?

The 2020 ACR gout treatment guideline conditionally recommends losartan as the preferred antihypertensive for people with gout. Losartan is the only ARB with consistent evidence of lowering serum uric acid. Calcium channel blockers like amlodipine have also been associated with a lower risk of incident gout. For more details, see our article on Your Blood Pressure Pill Might Be Behind Your Gout.

Should I switch from valsartan to losartan if I have gout?

That depends on why you are taking valsartan. If you are taking it for uncomplicated hypertension, switching to losartan may offer the added benefit of uric acid lowering. But if you are taking valsartan for heart failure or after a heart attack, losartan may not be an adequate substitute. Do not switch without talking to your doctor first.

Can I take valsartan and allopurinol together?

Yes. Valsartan and allopurinol can be taken together safely. They work through completely different mechanisms and do not interact with each other. Many people take valsartan for cardiovascular protection and allopurinol for uric acid control at the same time.

Reviewed by the GoutSavvy Editorial Team