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Can Water Pill Like Spironolactone Lower Blood Pressure Significantly?
Question: Good day Doctor,
My 84 years old mother was recently diagnosed with Heart Failure but at very early stage. General symptoms include swollen legs (much better after taking water pills), frequent fatigue, sometime short of breath. She started taking Furosemide 20mg since March due to swollen leg, and added Spironolactone 25mg in early May when diagnosed as Heart failure.
She has been taking Bisoprolol and Losartan for a long time as she had AF. If she does not take Losartan, her blood pressure could be high, but if she takes them, her blood pressure occasionally could be quite low, especially an hour or two after meal. This has been going on for many months. But recently, for the past weeks, she feel her low blood pressure situation got more frequent and worse. It could be 90/45. Since ask has newly taken Spironolactone for the past a couple of months, she wonders if this could be the result of water pill. Can water pill like Spironolactone lower blood pressure significantly? We are trying to book time with her cardiologist but hope to get some immediate view from you. Wonder if she can stop Losartan temporarily until we see her cardiologist.
My 84 years old mother was recently diagnosed with Heart Failure but at very early stage. General symptoms include swollen legs (much better after taking water pills), frequent fatigue, sometime short of breath. She started taking Furosemide 20mg since March due to swollen leg, and added Spironolactone 25mg in early May when diagnosed as Heart failure.
She has been taking Bisoprolol and Losartan for a long time as she had AF. If she does not take Losartan, her blood pressure could be high, but if she takes them, her blood pressure occasionally could be quite low, especially an hour or two after meal. This has been going on for many months. But recently, for the past weeks, she feel her low blood pressure situation got more frequent and worse. It could be 90/45. Since ask has newly taken Spironolactone for the past a couple of months, she wonders if this could be the result of water pill. Can water pill like Spironolactone lower blood pressure significantly? We are trying to book time with her cardiologist but hope to get some immediate view from you. Wonder if she can stop Losartan temporarily until we see her cardiologist.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that when on atrial fibrillation blood pressure values may not be so reliable. The heart rhythm is irregular and blood pressure may vary on each measurement attempt.
It is necessary performing serial BP measurements.
If BP measurements are persistently low (like 90/45 mmHg), then your mother should stop Losartan, or reduce the daily dose (25 mg/day) unless she has no symptoms (like persistent fatigue, lightheadedness).
I would recommend performing NT-proBNP, daily check her fluid balance (water intake and elimination), her skin and tongue hydration, and body weight.
If signs of excessive water loss is evident, then daily Furosemide dose should be reduced (half the actual dose).
Then, you should discuss with her attending doctor on the above mentioned issues.
Hope to have been helpful!
In case of any further questions, please let me know!
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that when on atrial fibrillation blood pressure values may not be so reliable. The heart rhythm is irregular and blood pressure may vary on each measurement attempt.
It is necessary performing serial BP measurements.
If BP measurements are persistently low (like 90/45 mmHg), then your mother should stop Losartan, or reduce the daily dose (25 mg/day) unless she has no symptoms (like persistent fatigue, lightheadedness).
I would recommend performing NT-proBNP, daily check her fluid balance (water intake and elimination), her skin and tongue hydration, and body weight.
If signs of excessive water loss is evident, then daily Furosemide dose should be reduced (half the actual dose).
Then, you should discuss with her attending doctor on the above mentioned issues.
Hope to have been helpful!
In case of any further questions, please let me know!
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Sharka! some follow up questions on BNP test to seek your guidance:
- what is the difference between BNP and NT-proBNP? Are they the same or different?
- She had a BNP test in May and result is 245 pg/ml, above the normal level (reports show normal range is <126). Mathmatically the number is a lot higher that 126 but I assume this still shows early stage of Heart failure? If she does a test again, how normally the doctor interpret the result if it is higher or lower than the 245pg/ml result in May? I assume if the level is lower than the May level, then we could say her condition is under control and the doctor may consider lowering Ferosemide?
Thank you again!
Helen
- what is the difference between BNP and NT-proBNP? Are they the same or different?
- She had a BNP test in May and result is 245 pg/ml, above the normal level (reports show normal range is <126). Mathmatically the number is a lot higher that 126 but I assume this still shows early stage of Heart failure? If she does a test again, how normally the doctor interpret the result if it is higher or lower than the 245pg/ml result in May? I assume if the level is lower than the May level, then we could say her condition is under control and the doctor may consider lowering Ferosemide?
Thank you again!
Helen
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again dear Helen!
I would explain that BNP and NT-proBNP are components of the same metabolic pathway. They are almost equivalent, though with different normal ranges.
Your mother's BNP levels confirm clinical heart failure. Followup tests are required for evaluation of her clinical conditions under therapy. A lower followup BNP result confirms she is on the right way of HF management. Otherwise, therapy modification is required.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again dear Helen!
I would explain that BNP and NT-proBNP are components of the same metabolic pathway. They are almost equivalent, though with different normal ranges.
Your mother's BNP levels confirm clinical heart failure. Followup tests are required for evaluation of her clinical conditions under therapy. A lower followup BNP result confirms she is on the right way of HF management. Otherwise, therapy modification is required.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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