Blood pressure-lowering efficacy of loop diuretics for primary hypertension

Abstract

Based on the limited number of published RCTs, the systolic/diastolic blood pressure-lowering effect of loop diuretics is -8/-4 mmHg, which is likely an overestimate. We graded the quality of evidence for both systolic and diastolic blood pressure estimates as "low" due to the high risk of bias of included studies and the high likelihood of publication bias. We found no clinically meaningful blood pressure-lowering differences between different drugs within the loop diuretic class. The dose-ranging effects of loop diuretics could not be evaluated. The review did not provide a good estimate of the incidence of harms associated with loop diuretics because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.

Prevalence and correlates of uncontrolled hypertension and cardiovascular morbidity among patients with hypertension at the largest tertiary care hospital in Sri Lanka

“…This can be explained by the high rates of cardiac morbidity among the patients. Although the BP-lowering effect of a loop diuretic like furosemide is modest [36], the use of furosemide nearly halved the odds of uncontrolled HTN in our study. Although beta blocker use was higher among those with cardiac morbidity, dihydropyridine CCBs were the antihypertensive of choice for those with a history of stroke.…”

Prevalence and correlates of uncontrolled hypertension and cardiovascular morbidity among patients with hypertension at the largest tertiary care hospital in Sri Lanka

“…This can be explained by the high rates of cardiac morbidity among the patients. Although the BP-lowering effect of a loop diuretic like furosemide is modest [36], the use of furosemide nearly halved the odds of uncontrolled HTN in our study. Although beta blocker use was higher among those with cardiac morbidity, dihydropyridine CCBs were the antihypertensive of choice for those with a history of stroke.…”

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

“…Thus, the single antihypertensive that relatively gave significant results in reducing the blood pressure profile was amlodipine. In a systematic review study evaluating the decrease in blood pressure from the use of a class of diuretic therapy including furosemide, it was stated that there was no clinically significant difference in the reduction of SBP and DBP between drugs in the loop diuretic class (Musini et al, 2015). The use of combination antihypertensives is generally also carried out to achieve therapeutic goals, more effective lowering of blood pressure, reducing side effects to improve patient compliance.…”

Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

“…Findings from the current review are similar to those of the 2 previous systematic reviews: positive evidence was found supporting pharmacist interventions for improving systolic and diastolic BP control among outpatients. The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg . The interventions – conducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapist – were most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication).…”

“…The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg. 56 The interventionsconducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapistwere most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication). A substantial heterogeneity in the effect estimate was observed for both systolic and diastolic BP.…”

Prevalence and correlates of uncontrolled hypertension and cardiovascular morbidity among patients with hypertension at the largest tertiary care hospital in Sri Lanka

“…This can be explained by the high rates of cardiac morbidity among the patients. Although the BP-lowering effect of a loop diuretic like furosemide is modest [36], the use of furosemide nearly halved the odds of uncontrolled HTN in our study. Although beta blocker use was higher among those with cardiac morbidity, dihydropyridine CCBs were the antihypertensive of choice for those with a history of stroke.…”

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

“…Thus, the single antihypertensive that relatively gave significant results in reducing the blood pressure profile was amlodipine. In a systematic review study evaluating the decrease in blood pressure from the use of a class of diuretic therapy including furosemide, it was stated that there was no clinically significant difference in the reduction of SBP and DBP between drugs in the loop diuretic class (Musini et al, 2015). The use of combination antihypertensives is generally also carried out to achieve therapeutic goals, more effective lowering of blood pressure, reducing side effects to improve patient compliance.…”

Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

“…Findings from the current review are similar to those of the 2 previous systematic reviews: positive evidence was found supporting pharmacist interventions for improving systolic and diastolic BP control among outpatients. The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg . The interventions – conducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapist – were most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication).…”

“…The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg. 56 The interventionsconducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapistwere most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication). A substantial heterogeneity in the effect estimate was observed for both systolic and diastolic BP.…”

Prevalence and correlates of uncontrolled hypertension and cardiovascular morbidity among patients with hypertension at the largest tertiary care hospital in Sri Lanka

“…This can be explained by the high rates of cardiac morbidity among the patients. Although the BP-lowering effect of a loop diuretic like furosemide is modest [36], the use of furosemide nearly halved the odds of uncontrolled HTN in our study. Although beta blocker use was higher among those with cardiac morbidity, dihydropyridine CCBs were the antihypertensive of choice for those with a history of stroke.…”

Comparison of Blood Pressure in Hypertensive Patients with Monotherapy and Combination Antihypertensive Therapy

“…Thus, the single antihypertensive that relatively gave significant results in reducing the blood pressure profile was amlodipine. In a systematic review study evaluating the decrease in blood pressure from the use of a class of diuretic therapy including furosemide, it was stated that there was no clinically significant difference in the reduction of SBP and DBP between drugs in the loop diuretic class (Musini et al, 2015). The use of combination antihypertensives is generally also carried out to achieve therapeutic goals, more effective lowering of blood pressure, reducing side effects to improve patient compliance.…”

Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

“…Findings from the current review are similar to those of the 2 previous systematic reviews: positive evidence was found supporting pharmacist interventions for improving systolic and diastolic BP control among outpatients. The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg . The interventions – conducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapist – were most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication).…”

“…The observed effect was indeed substantial compared with powerful antihypertensive drugs like loop diuretics that decrease systolic blood pressure, on average, by 8 mm Hg. 56 The interventionsconducted by the pharmacist alone or in collaboration with physician, nurse or dietitian, or physical therapistwere most often educational interventions to patients about medication, lifestyle and physical activity, feedback to physician (such as recommendation regarding medications changes or problems to medication adherence), and medication management (such as drug monitoring with adjustment or change in medication). A substantial heterogeneity in the effect estimate was observed for both systolic and diastolic BP.…”