From the Guidelines
Diuretics should be held or adjusted in patients with low diastolic blood pressure (DBP), particularly if symptomatic, to prevent potential complications such as compromised coronary perfusion, volume depletion, and electrolyte abnormalities. According to 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 1, the use of inappropriately high doses of diuretics can lead to volume contraction, which can increase the risk of hypotension and renal insufficiency.
When considering holding diuretics, it's essential to monitor the patient's blood pressure regularly and consider resuming at a lower dose once the DBP normalizes. The decision to hold diuretics should be individualized based on the patient's overall clinical status, comorbidities, and the indication for diuretic therapy. Common diuretics that might need adjustment include hydrochlorothiazide, chlorthalidone, furosemide, bumetanide, and spironolactone.
Key considerations in managing patients with low DBP include:
- Monitoring blood pressure regularly
- Adjusting diuretic doses or switching to alternative antihypertensive medications
- Considering the patient's symptoms, comorbidities, and indication for diuretic therapy
- Being aware of potential complications such as compromised coronary perfusion, volume depletion, and electrolyte abnormalities, as highlighted in the guideline 1.
In clinical practice, holding or adjusting diuretics in patients with low DBP can help mitigate these risks and improve patient outcomes, as suggested by the guideline 1.
From the Research
Diuretics and Blood Pressure
- The use of diuretics in treating hypertension is well-established, with thiazide diuretics being a common choice 2, 3, 4.
- Loop diuretics have also been shown to lower blood pressure, although their use in hypertension is less common due to a lack of outcome data 5, 6.
Blood Pressure Lowering Efficacy
- Thiazide diuretics have been shown to lower systolic and diastolic blood pressure in a dose-related manner, with a mean reduction of 9 mmHg / 4 mmHg compared to placebo 4.
- Loop diuretics have also been shown to lower blood pressure, with a mean reduction of 7.9 mmHg / 4.4 mmHg compared to placebo 6.
Low Diastolic Blood Pressure
- There is no direct evidence to suggest that diuretics should be held for low diastolic blood pressure (DBP) 2, 5, 3, 4, 6.
- However, it is important to consider the potential risks of diuretic use, including hypokalemia, hyponatremia, and increased uric acid levels, particularly in patients with low DBP 3, 4.
Clinical Considerations
- The decision to hold diuretics for low DBP should be made on a case-by-case basis, taking into account the individual patient's clinical circumstances and medical history 2, 5, 3, 4, 6.
- Clinicians should carefully monitor patients' blood pressure and adjust their treatment regimen as needed to minimize the risk of adverse effects 2, 5, 3, 4, 6.