Blood Pressure Effects and Risk of Hypotension due to Intravenous Furosemide in Acute Decompensated Heart Failure

TL;DR

Intravenous furosemide causes only small and temporary drops in blood pressure during heart failure treatment, with hypotension being rare and mostly influenced by other factors.

Contribution

This study quantifies the specific blood pressure effects and hypotension risk of IV furosemide in heart failure patients, showing minimal impact compared to other factors.

Findings

IV furosemide accounts for only 1.4% of blood pressure variance and 1.7% of hypotension risk.

Hypotension risk from IV furosemide is low when baseline blood pressure is ≥90 mmHg.

Blood pressure effects of IV furosemide are transient, returning to baseline within 6 hours.

Abstract

We quantified the magnitude of systolic blood pressure (SBP) adverse effects associated with intravenous furosemide (IVFu), compared to other factors, during treatment for acute decompensated heart failure (ADHF).

Continuous BP monitoring (598.2 person‐hours, 91,210 observations) before and after IVFu was performed in a prospective multicenter ADHF cohort (n = 253). Multivariable‐adjusted mixed effects regression was used to determine the amount of SBP reduction and the risk of hypotension attributable to IVFu administration, as opposed to confounders (e.g., non‐IVFu treatments and baseline patient characteristics).

Median SBP was 124 mmHg (IQR: 105–149) at baseline. Hypotension occurred in 5515 observations (6.0%). The multivariable models explained 79.6% and 58.1% of variance in SBP and risk of hypotension, respectively. Only 1.4% of variance in SBP and 1.7% of hypotension risk were related to IVFu, with the remainder accounted for by confounders. After multivariable adjustment, SBP dropped −11.9 mmHg on average after 80 mg IVFu, reaching a nadir at 147 min (−15.2 mmHg) and partial return to baseline by 6 h (−8.5 mmHg). IVFu‐related risk of hypotension after multivariable adjustment depended predominantly on baseline SBP and dose. Risk of hypotension associated with 80 mg IVFu was ≤ 2% with baseline SBP ≥ 120 mmHg. For 40 mg, IVFu‐associated hypotensive risk was ≤ 2% with SBPs of 90–100 mmHg, and < 1% with SBP ≥ 110 mmHg. IVFu‐associated risk of hypotension returned to zero at 6 h after administration, regardless of dose.

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.

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