From the Guidelines
Antihypertensive medications are not the primary treatment for pulmonary embolism (PE) and should not be used as a replacement for anticoagulation therapy. The standard treatment for PE includes anticoagulants (blood thinners) such as heparin, low molecular weight heparins like enoxaparin, or direct oral anticoagulants (DOACs) like rivaroxaban, apixaban, or edoxaban, as recommended by the 2019 ESC guidelines 1. These medications prevent existing clots from growing and new clots from forming. In severe cases with hemodynamic instability, thrombolytic therapy (clot busters) like alteplase may be used, as suggested by the guidelines 1.
Some key points to consider in the treatment of PE include:
- Initiation of anticoagulation without delay in patients with high or intermediate clinical probability of PE, while diagnostic workup is in progress 1
- Recommendation of low molecular weight heparin (LMWH) or fondaparinux over unfractionated heparin (UFH) for most patients 1
- Preference for direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) in eligible patients 1
- Consideration of rescue thrombolytic therapy or surgical embolectomy for patients with hemodynamic deterioration on anticoagulation treatment 1
However, if a patient develops right heart strain or pulmonary hypertension as a complication of PE, certain blood pressure medications like sildenafil or riociguat might be prescribed to reduce pulmonary vascular resistance, as part of a comprehensive treatment plan. Additionally, if the patient has concurrent hypertension, their regular blood pressure medications should generally be continued during PE treatment, but they are not part of the PE treatment itself. Always consult with a healthcare provider for personalized treatment recommendations for pulmonary embolism.
From the FDA Drug Label
1.3 Treatment of Pulmonary Embolism 1.4 Reduction in the Risk of Recurrence of Deep Vein Thrombosis and/or Pulmonary Embolism 5.9 Acute PE in Hemodynamically Unstable Patients or Patients Who Require Thrombolysis or Pulmonary Embolectomy 14.2 Treatment of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE) 14.3 Reduction in the Risk of Recurrence of DVT and/or PE
The FDA drug label does not answer the question about the effectiveness of antihypertensive medications for treating pulmonary embolism, as the provided label is for rivaroxaban, an anticoagulant medication. 2
From the Research
Effectiveness of Antihypertensive Medications for Pulmonary Embolism
- There is no direct evidence to suggest that antihypertensive medications are effective for treating pulmonary embolism 3, 4, 5, 6, 7.
- The primary treatment for pulmonary embolism involves anticoagulation therapy, which includes medications such as heparin, low molecular weight heparins, and direct oral anticoagulants (DOACs) like apixaban, edoxaban, rivaroxaban, and dabigatran 4, 5, 6, 7.
- In patients with pulmonary embolism and systolic blood pressure lower than 90 mm Hg, systemic thrombolysis is recommended, which may involve the use of medications like norepinephrine, isoproterenol hydrochloride, or epinephrine 3, 4.
- The use of antihypertensive medications in the context of pulmonary embolism is not well-established, and their effectiveness for this condition is not supported by the available evidence 3, 4, 5, 6, 7.
Treatment Options for Pulmonary Embolism
- Anticoagulation therapy is the primary treatment for pulmonary embolism, with the goal of preventing further clot formation and reducing the risk of recurrence 4, 5, 6, 7.
- The choice of anticoagulant therapy depends on the patient's clinical presentation, risk factors, and other individual characteristics 4, 5, 6, 7.
- In patients with high or intermediate clinical probability of pulmonary embolism, anticoagulation should be initiated without delay while awaiting the results of diagnostic tests 5.
- The duration of anticoagulation therapy should be individualized based on the patient's risk of recurrence and bleeding 5.