From the Guidelines
Yes, volume overload can cause hypertension, as it increases the total blood volume circulating through the cardiovascular system, directly raising pressure within blood vessels. This is supported by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, which recommends diuretics to control hypertension in adults with HFpEF who present with symptoms of volume overload 1.
Pathophysiology of Volume Overload and Hypertension
Volume overload commonly occurs in conditions like kidney disease, heart failure, and excessive sodium intake. The kidneys play a crucial role in this process through the renin-angiotensin-aldosterone system, which regulates fluid balance. When this system becomes dysregulated, sodium and water retention increases, expanding blood volume and raising blood pressure.
Treatment of Volume Overload and Hypertension
Treatment typically focuses on addressing the underlying cause while reducing fluid volume through diuretics like furosemide (20-80mg daily), hydrochlorothiazide (12.5-50mg daily), or spironolactone (25-100mg daily) 1. Dietary sodium restriction (less than 2,300mg daily) is also essential. The body normally maintains blood pressure through a balance of cardiac output and peripheral resistance, but when volume increases significantly, this homeostasis is disrupted, resulting in hypertension.
Clinical Considerations
In adults with HFpEF and persistent hypertension after management of volume overload, ACE inhibitors or ARBs and beta blockers should be prescribed and titrated to attain SBP of less than 130 mm Hg 1. It's also important to consider the pathogenesis of hypertension in specific patient populations, such as those with kidney disease, where fluid overload secondary to sodium and water retention is a common cause of hypertension 1.
Key Recommendations
- Diuretics should be prescribed to control hypertension in adults with HFpEF who present with symptoms of volume overload 1.
- ACE inhibitors or ARBs and beta blockers should be prescribed and titrated to attain SBP of less than 130 mm Hg in adults with HFpEF and persistent hypertension after management of volume overload 1.
- Dietary sodium restriction (less than 2,300mg daily) is essential.
From the Research
Volume Overload and Hypertension
- Volume overload is defined as excess total body sodium and water with expansion of extracellular fluid volume, and is a key modifiable contributor to hypertension and cardiovascular disease in certain populations 2.
- Studies have shown that volume overload can lead to hypertension in patients with end-stage renal disease, congestive heart failure, and other conditions 3, 2.
- However, some research suggests that volume overload per se may not directly raise arterial blood pressure, but rather leads to sympathetic activation and a hyperadrenergic state that contributes to hypertension 4.
- Fluid overload is a common issue in critically ill patients and is associated with increased mortality and adverse outcomes, including pulmonary edema, cardiac failure, and delayed wound healing 5.
Mechanisms and Treatment
- Diuretics, particularly loop diuretics, are a cornerstone of therapy for volume overload and hypertension, and can help to reduce fluid overload and improve outcomes in patients with heart failure and other conditions 3, 5, 6.
- Other treatment strategies for volume overload include sodium restriction, fluid restriction, and ultrafiltration, as well as the use of vasopressin antagonists and other medications 6.
- Accurate evaluation of volume status is essential for effective treatment of volume overload, and can be achieved through a combination of clinical assessment, laboratory tests, and imaging studies 5.