From the FDA Drug Label
Furosemide tablets are indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. Oral Furosemide tablets may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents.
The FDA drug label does not answer the question.
From the Research
A calcium channel blocker is generally better than furosemide for treating hypertension in a patient with hyperkalemia. Calcium channel blockers like amlodipine (5-10 mg daily), nifedipine (30-90 mg daily in extended-release form), or diltiazem (120-540 mg daily) effectively lower blood pressure without affecting potassium levels, as shown in a study published in 2021 1. This is particularly advantageous in hyperkalemic patients since these medications are potassium-neutral.
Key Points to Consider
- In contrast, furosemide, while effective for hypertension, can worsen hyperkalemia in certain situations, particularly in patients with renal impairment or those taking potassium-sparing medications.
- Loop diuretics like furosemide typically promote potassium excretion, but their effectiveness depends on adequate kidney function and can be unpredictable in complex cases.
- Calcium channel blockers work by blocking calcium entry into vascular smooth muscle cells, causing vasodilation and reduced peripheral resistance, thereby lowering blood pressure without disrupting electrolyte balance.
- According to a study published in 2009, calcium channel blockers are recommended as first-line antihypertensive drugs to treat essential hypertension 2.
- When treating a hyperkalemic hypertensive patient, it's also important to address the underlying cause of hyperkalemia while managing the hypertension, as highlighted in a study published in 2019 3.
Additional Considerations
- The use of anti-hyperkalemic agents may allow for a less restrictive potassium diet and lower RAASi discontinuation rates, as shown in a study published in 2019 3.
- Pharmacological targeting of WNKs or their substrates offers promising options to manage hypertension while preventing hyperkalemia, as discussed in a study published in 2019 4.
- Novel cation exchange polymers present the clinician with a new and safe strategy to address hyperkalemia in patients with a compelling indication for ongoing RAASi therapy instead of withdrawal of such therapy, as highlighted in a study published in 2018 5.