Which medications in the drug class Diuretics, Loop are used in the treatment of Hypertension?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Diuretics, Loop

Loop diuretics act on the ascending limb of the loop of Henle, inhibiting the reabsorption of sodium and chloride. The loop diuretics are highly protein-bound and therefore enter the urine primarily by tubular secretion in the proximal tubule, rather than by glomerular filtration.

Loop diuretics are commonly used to control volume retention. Generally, thiazide diuretics are recommended for most patients with a diagnosis of hypertension; however, loop diuretics are more commonly prescribed for patients with decreased glomerular filtration rate or heart failure. Loop diuretics do not reduce blood pressure as effectively as thiazide diuretics when they are used as monotherapy, especially if they are dosed once daily.

Keep in mind that all available loop and thiazide diuretic agents, except ethacrynic acid, possess a sulfonamide group, which has important clinical relevance to those individuals with allergies to sulfonamide agents.

Furosemide (Lasix)

Furosemide is approved for the treatment of hypertension alone (uncommon) or in combination with other antihypertensive agents. Hypertensive patients who cannot be adequately controlled with thiazides will probably also not be adequately controlled with furosemide alone. The initial dosing recommendations for hypertension are usually 80 mg (divided into 40 mg twice a day). If clinical response is not sufficient, additional antihypertensives may be added. Patients should be monitored carefully because furosemide is a potent diuretic. If given in excessive amounts, it can cause profound diuresis with water and electrolyte depletion. Furosemide is available as an oral tablet and injection solution.

Torsemide (Demadex)

Torsemide can be used as monotherapy or in combination with other antihypertensive agents. The initial dose is 5 mg once daily. The dose can be titrated to 10 mg once daily. If adequate response is not seen, an additional antihypertensive agent may be needed. Torsemide is available as an oral tablet and injection solution.

Bumetanide

Bumetanide is FDA approved for the treatment of edema. It is also used off-label for the treatment of hypertension. The usual dosage range for bumetanide for hypertension is 0.5-2 mg/day given once or twice a day. [3]


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