Which antihypertensive class should a patient with acute gouty arthritis avoid?

A patient with acute gouty arthritis should avoid thiazide diuretics because these medications have been associated with increased levels of uric acid in the blood. Elevated uric acid can exacerbate gout symptoms by promoting the formation of urate crystals in the joints, leading to painful inflammation characteristic of a gout attack. Thiazide diuretics, while effective for managing hypertension, can precipitate or worsen gout due to their impact on renal clearance of uric acid.

In contrast, the other classes of antihypertensive medications, such as beta-blockers, ACE inhibitors, and calcium channel blockers, do not have this same association with increased levels of uric acid and are generally safer options for patients with a history of gout. While some beta-blockers can have varying effects on uric acid, they are not typically contraindicated in the way thiazides are for gout management. ACE inhibitors and calcium channel blockers are more neutral in their effects on uric acid levels, making them preferable choices for hypertensive patients with acute gout.