Can Lasix (furosemide) be used to reduce blood pressure?

Use of Lasix (Furosemide) for Blood Pressure Reduction

Lasix (furosemide) is not recommended as a primary agent for blood pressure reduction, as it can cause transient worsening of hemodynamics with increased heart rate, mean arterial pressure, and decreased stroke volume. 1

Hemodynamic Effects of Furosemide

• IV furosemide administration (1.3 mg/kg) results in a transient (1-2 hour) worsening of hemodynamics, including increased heart rate, mean arterial pressure, left ventricular filling pressure, and decreased stroke volume 1
• Furosemide initially lowers stroke volume and increases systemic vascular resistance 1
• While furosemide can significantly lower mean arterial pressure compared to baseline, this effect is not consistent or predictable 1

Furosemide in Hypertension Management

• According to the FDA label, furosemide can be used for hypertension, but with specific dosing recommendations:
  • Initial dose is typically 80 mg daily, usually divided into 40 mg twice daily 2
  • Dosage should be adjusted according to blood pressure response 2
  • When used with other antihypertensive drugs, the dosage of those agents should be reduced by at least 50% when furosemide is added to prevent excessive blood pressure drops 2

Preferred Agents vs. Furosemide for Blood Pressure Control

• Nitrates have shown improved cardiac output compared to furosemide in randomized controlled trials 1
• In studies comparing nitrates with furosemide for acute heart failure with pulmonary edema, nitrates were more effective at improving hemodynamics 1
• For primary hypertension management, thiazide diuretics are more commonly recommended as first-line diuretic therapy 3

Risks and Concerns with Furosemide for Blood Pressure Control

• Furosemide can cause unpredictable effects on sodium balance and may worsen kidney function 4
• Higher loop diuretic doses are associated with worsening renal function during hospitalization 1
• Worsening renal function is associated with increased in-hospital mortality (OR=2.7,95% CI 1.6-4.6) 1
• Diuretics should be administered judiciously given the potential association between diuretics, worsening renal function, and long-term mortality 1

Special Populations

• In elderly patients, dose selection should be cautious, usually starting at the low end of the dosing range 2
• In patients with cirrhosis and ascites, the combination of spironolactone and furosemide is typically recommended rather than furosemide alone 1
• In patients with cardiac amyloidosis and volume overload, orally administered torsemide or bumetanide may be more effective than oral furosemide when there is significant intestinal wall edema 1

Practical Recommendations

• If furosemide must be used for hypertension:
  • Start with 40 mg twice daily (total 80 mg/day) 2
  • Monitor blood pressure response and adjust dosage accordingly 2
  • Be vigilant for worsening renal function, electrolyte disturbances, and dehydration 1, 4
  • Consider alternative or additional antihypertensive agents if response is inadequate 2

In conclusion, while furosemide can lower blood pressure, it is not an ideal first-line agent for hypertension management due to its unpredictable effects and potential for adverse outcomes, particularly related to renal function.