What is the role of diuretics in the management of pulmonary arterial hypertension (PAH)?

Updated: Apr 25, 2018
  • Author: Kristin E Schwab, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Although no randomized controlled trials have evaluated diuretics for pulmonary arterial hypertension (PAH), practitioners frequently use these based on their clear value for fluid removal in patients with evidence of right-sided heart volume overload. Loop diuretics such as furosemide and bumetanide are first line, with aldosterone antagonists sometimes considered as adjunctive agents.

Diuretics are indicated in patients with PAH who have signs of right-sided heart volume overload, as evidenced by lower extremity edema, ascites, hepatic congestion, or elevated jugular venous pressure. As patients with right-sided heart failure are preload dependent, however, caution must be used. Hypovolemia should be avoided, as this can lead to a drop in cardiac output and hemodynamic compromise.


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