The effects of the addition of micronised fenofibrate on uric acid metabolism in patients receiving indapamide.
OBJECTIVE
Hyperuricaemia is associated with indapamide administration. In contrast, micronised fenofibrate can significantly decrease serum uric acid levels. However, there are no data on the effect of combination therapy of indapamide with micronised fenofibrate on uric acid metabolism.


METHODS
We studied 20 non-diabetic hypertensive patients with mixed dyslipidaemia in whom serum metabolic parameters, including uric acid levels in serum and urine, were measured before and after eight weeks of indapamide administration (2.5 mg once daily). This study was continued for a further eight weeks, when the indapamide was combined with micronised fenofibrate (200 mg once daily).


RESULTS
Indapamide significantly decreased mean systolic and diastolic blood pressure (BP) from 153 +/- 9/97 +/- 8 mmHg to 138 +/- 8/93 +/- 4 mmHg (p< 0.05 for both comparisons). A significant increase in serum uric acid levels occurred after indapamide administration (from a mean value of 5.6 +/- 1.3 mg/dl (0.33 +/- 0.07 mmol/l) to 6.4 +/- 1.1 mg/dl (0.38 +/- 0.06 mmol/l), p < 0.01]. This effect was associated with a decrease in the fractional excretion of uric acid (from a mean value of 9.5 +/- 5% to 7 +/- 5.5%, p < 0.05). The addition of micronised fenofibrate significantly decreased plasma fibrinogen levels as well as total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB) and triglycerides, and increased high-density lipoprotein cholesterol and ApoA, levels. Fenofibrate administration was followed by a significant decrease in serum uric acid levels to 4.7 +/- 1.2 mg/dl (0.28 +/- 0.07 mmol/l), p < 0.01, owing to a substantial increase in fractional urate excretion to 11 +/- 3%, p < 0.01.


CONCLUSIONS
The addition of micronised fenofibrate can correct the hyperuricaemic effect of indapamide administration.
Achimastos
Apostolos
A
Department of Internal Medicine, Medical School, University of Athens, Greece.
Liberopoulos
Evagelos
E
Nikas
Spyros
S
Bairaktari
Eleni
E
Miltiadous
George
G
Tsimihodimos
Vasilios
V
Elisaf
Moses
M
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001055:Apolipoproteins B / Q000097:blood; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D011345:Fenofibrate / Q000008:administration & dosage* / Q000494:pharmacology; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D007190:Indapamide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood / Q000378:metabolism* / Q000652:urine
D000959:Antihypertensive Agents; D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D014280:Triglycerides; D014527:Uric Acid; D005340:Fibrinogen; D002784:Cholesterol; D007190:Indapamide; D011345:Fenofibrate