A patient was being treated for hypertension, with significantly elevated systolic blood pressure. Systolic blood pressures(BP) were running in the 150-160 range. Hydrochlorothiazide was the drug that was chosen to help treat the elevated BP. The dosing was 25 mg daily. After a couple of weeks, the blood pressures were lower by about 10-15 points, and follow up kidney labs and electrolytes were stable. Hydrochlorothiazide is a “thiazide” diuretic, real original I know. About a month later, this patient had an acute gout flare and a uric acid level was checked and elevated. Allopurinol was added to treat the elevation in uric acid. What was missed however, was that hydrochlorothiazide can have this adverse effect of causing uric acid levels to increase.