In this episode, I’ll discuss the risk of hypotension when giving IV furosemide for acute decompensated heart failure.
Patients who present with acute decompensated heart failure often also have hypotension, and clinicians are often concerned that treatment with furosemide, while it will address fluid overload might also result in symptomatic hypotension. If this concern results in withholding treatment with furosemide or underdosing it, this could lead to increased rates of re-admission or mortality.
A group of authors sought to quantify the effects on blood pressure of IV furosemide when given to patients with acute decompensateed heart failure and published their findings in Academic Emergency Medicine.
Continuous blood pressure monitoring in 253 patients with acute decompensated heart failure was performed before and after IV furosemide bolus injection. While hypotension did occur in 6% of the measurements, the authors conducted a multivariable adjustment that showed only 1.7% of the risk of hypotension could be attributed to the IV furosemide with the majority being from confounders.
Furthermore the authors found that IV furosemide-related risk of hypotension after multivariable adjustment depended predominantly on baseline SBP and furosemide dose. The risk of hypotension after 80 mg IV furosemide was ≤ 2% with baseline SBP ≥ 120 mmHg. The risk of hypotension after 40 mg IV furosemide was ≤ 2% with SBPs of 90–100 mmHg, and < 1% with SBP ≥ 110 mmHg. IV furosemide-associated risk of hypotension returned to zero at 6 hours after administration, regardless of whether a 40 mg or 80 mg dose was given. The authors concluded:
Blood pressure reductions after IVFu during ADHF treatment are modest, and hypotension is rare and transient. Most variance in SBP during ADHF treatment is due to other factors.
Pharmacists can use this information to encourage providers to give aggressive and complete diuresis to patients with acute decompensated heart failure to reduce the chance of readmission or mortality.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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