From the Guidelines
Irbesartan should be held if a patient's blood pressure is low, as it can further reduce blood pressure to potentially dangerous levels. Irbesartan is an angiotensin II receptor blocker (ARB) that works by relaxing blood vessels, which lowers blood pressure. When a patient already has low blood pressure (hypotension), administering irbesartan could exacerbate the condition, leading to symptoms such as dizziness, lightheadedness, fainting, or in severe cases, inadequate blood flow to vital organs. The decision to hold irbesartan should be based on specific blood pressure readings, with systolic blood pressure below 90 mmHg or diastolic below 60 mmHg generally considered thresholds for concern, as suggested by general clinical guidelines 1. Once blood pressure returns to an acceptable range, irbesartan therapy can be resumed, possibly at a lower dose. Patients should contact their healthcare provider before restarting the medication after it has been held for low blood pressure to ensure appropriate management of their condition. Key considerations in managing hypertension and the use of ARBs like irbesartan include the importance of blood pressure control in preventing cardiovascular outcomes, as highlighted in recent guidelines 1. However, the primary concern in the context of hypotension is the potential for ARBs to worsen low blood pressure, necessitating careful monitoring and adjustment of medication as needed. In clinical practice, the management of hypertension and the use of medications like irbesartan must balance the benefits of blood pressure control with the risks of hypotension, particularly in vulnerable populations 1.
From the FDA Drug Label
5.2 Hypotension in Volume- or Salt-Depleted Patients In patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e. g. those being treated with high doses of diuretics), symptomatic hypotension may occur after initialization of treatment with irbesartan. Correct volume or salt depletion prior to administration of irbesartan or use a lower starting dose [see Dosage and Administration (2.4)].
Irbesartan can cause hypotension in certain patients, particularly those who are volume- or salt-depleted. To manage this risk, the drug label recommends:
- Correcting volume or salt depletion prior to administration of irbesartan
- Using a lower starting dose in these patients It does not explicitly state that irbesartan should be held for hypotension, but rather provides guidance on how to mitigate the risk of hypotension when initiating treatment with irbesartan 2.
From the Research
Irbesartan and Hypotension
- There is no direct evidence in the provided studies that irbesartan is held for hypotension (low blood pressure) 3, 4, 5, 6, 7.
- The studies focus on the use of irbesartan in treating hypertension and its effects on blood pressure control, rather than its use in hypotension 3, 4, 5, 6, 7.
Blood Pressure Control with Irbesartan
- Irbesartan has been shown to be effective in reducing blood pressure over a 24-hour period with once-daily administration 3, 4, 5, 6, 7.
- The drug has been found to provide significant dose-related reductions in blood pressure in patients with mild-to-moderate hypertension 5.
- Irbesartan has also been shown to slow the progression of renal disease in patients with hypertension and type 2 diabetes, with this effect being at least partly independent of its blood pressure-lowering effect 3, 4, 6.