Preventing Rebound Hypertension When Discontinuing Hydralazine
Understanding Hydralazine and Rebound Risk
- The American College of Cardiology and Hypertension society recommend that hydralazine should always be used with a diuretic and beta-blocker, as it causes increased sympathetic tone and sodium retention 1, 2, 3
- Hydralazine is associated with sodium and water retention and reflex tachycardia when used alone, according to the Hypertension society 4
- The Hypertension society notes that hydralazine may cause drug-induced lupus-like syndrome at higher doses (>150 mg daily) 5
Recommended Approach to Discontinuation
- The American College of Cardiology recommends maintaining patients on a diuretic and beta-blocker during the tapering process, with beta-blockers counteracting the increased sympathetic tone that occurs with hydralazine therapy and during withdrawal 1, 2, 3, 5
- The American College of Cardiology suggests monitoring blood pressure regularly during the tapering process 1
Common Pitfalls to Avoid
- The American College of Cardiology and Hypertension society advise against discontinuing hydralazine abruptly, as this increases the risk of rebound hypertension, and also recommend not discontinuing beta-blockers simultaneously, as abrupt cessation can cause rebound hypertension 1, 2
- The Hypertension society notes that hydralazine causes sodium retention that persists during discontinuation, highlighting the need for continued diuretic therapy 5