From the Guidelines
Lasix (furosemide) should typically be held when systolic blood pressure (SBP) falls below 90 mmHg due to the risk of hypotension. This recommendation is based on the medication's potent diuretic effect, which can further reduce blood pressure by decreasing intravascular volume 1. When administering Lasix, it's essential to monitor blood pressure before each dose, especially in patients who are already volume depleted, elderly, or taking other antihypertensive medications.
Key Considerations
- The threshold for holding Lasix may need to be adjusted higher for patients who normally have higher baseline blood pressures or lower for those who typically run lower pressures but remain asymptomatic.
- Clinical judgment should be used if a patient's SBP is between 90-100 mmHg, potentially reducing the dose rather than withholding it completely.
- Once blood pressure stabilizes above 90 mmHg, Lasix can generally be resumed, often starting at a lower dose with careful monitoring.
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends considering the recent need to escalate diuretics to maintain volume status and frequent SBP ≤90 mm Hg as indicators of advanced heart failure 1.
Monitoring and Adjustment
- Monitor blood pressure closely before each dose of Lasix, especially in high-risk patients.
- Adjust the dose of Lasix based on the patient's response and blood pressure readings.
- Consider alternative treatments or adjustments to the treatment plan if the patient's blood pressure remains below 90 mmHg despite holding Lasix.
From the Research
Parameters to Hold Lasix for SBP
The parameters to hold Lasix (furosemide) due to the risk of hypotension are not explicitly stated in the provided studies. However, the studies suggest that furosemide can cause hypotension, particularly in elderly patients with heart failure 2, 3.
Risk of Hypotension
- Furosemide can decrease postprandial systolic blood pressure and frontal cortical oxygenation in elderly patients with heart failure 2.
- Withdrawal of furosemide therapy can improve postprandial blood pressure homeostasis in elderly patients with heart failure and preserved left ventricular systolic function 3.
- Intensive systolic blood pressure control, which may involve the use of furosemide, is associated with a greater risk of hypotension and possibly syncope in adults aged 50 and older 4.
Systolic Blood Pressure (SBP) Levels
- The studies do not provide a specific SBP level at which Lasix should be held due to the risk of hypotension.
- However, one study suggests that standing SBP less than 110 mmHg may be a contraindication for intensive systolic blood pressure control 4.
- Another study found that the maximum postprandial systolic BP decline was correlated with the ratio of early to late flow in patients with heart failure 3.
Patient Characteristics
- Elderly patients with heart failure are at risk of postprandial hypotension and orthostatic hypotension due to altered cardiovascular balance and the use of cardiovascular medications, such as furosemide 2, 3.
- Patients with chronic kidney disease or frailty are at higher risk of hypotension and other adverse events 4.