In Hypertensive Urgency With Volume Overload—Intravenous Loop Diuretic may be Indicated

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Hypertensive urgency with volume overload. Intervention: Intravenous loop diuretic vs. Peroral diuretic or standard oral antihypertensives.

Goran Pante Koracevic; Milovan Stojanović

doi:10.1111/jch.70377

October 1, 2026Journal of Clinical HypertensionOpen Access

In Hypertensive Urgency With Volume Overload—Intravenous Loop Diuretic may be Indicated

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Key result

Intravenous loop diuretics may be a safe and effective treatment for hypertensive urgency with volume overload, avoiding the risk of excessive blood pressure drops associated with other intravenous antihypertensives.

Why the study?

Does intravenous loop diuretic administration safely stabilize blood pressure in patients with hypertensive urgency complicated by volume overload?

Key Points

To examine the therapeutic rationale and clinical safety of administering intravenous loop diuretics to patients presenting with hypertensive urgency accompanied by volume overload.
Clinical and pharmacological analysis evaluating intravenous loop diuretic administration in hypertensive urgency with concurrent volume overload.
Evaluation of blood pressure reduction profiles, symptom management, and risks of hypoperfusion associated with a standard dose of 20 mg furosemide.
A typical dose of an intravenous loop diuretic (20 mg furosemide) is not expected to drop blood pressure by more than 20/10 mmHg, presenting a very low risk of excessive pressure drop in patients with baseline levels of at least 180/110 mmHg.
Intravenous administration acts more rapidly and reliably than oral diuretics to eliminate excess volume, helping stabilize blood pressure across subsequent days and preventing progression to acute hypertension-mediated organ damage.
Intravenous loop diuretics should be avoided in patients presenting with signs of volume depletion, suspected hypokalemia, or heightened renal risk from nephrotoxic agents or high-dose renin-angiotensin system inhibitors.

Structured PICO

Does intravenous loop diuretic administration safely stabilize blood pressure in patients with hypertensive urgency complicated by volume overload?

P

Population

Patients with hypertensive urgency (blood pressure >= 180/110 mmHg) and volume overload.

I

Intervention

Intravenous loop diuretic (e.g., furosemide 20 mg).

C

Comparator

Peroral diuretic or guideline-recommended oral antihypertensives (dihydropyridine calcium channel blockers, renin-angiotensin system blockers).

Implication

Highlights a specific clinical niche (concomitant volume overload) where intravenous diuretics may be preferable to guideline-recommended oral therapies for managing hypertensive urgency.

Abstract

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Discussion

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Cite This Study

Koracevic et al. (2026) conducted a letter in Hypertensive urgency with volume overload. Intravenous loop diuretic vs. Peroral diuretic or standard oral antihypertensives was evaluated. Intravenous loop diuretics may be a safe and effective treatment for hypertensive urgency with volume overload, avoiding the risk of excessive blood pressure drops associated with other intravenous antihypertensives.

synapsesocial.com/papers/6acff4df77dfa7a7a65ccac8 https://doi.org/10.1111/jch.70377

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In Hypertensive Urgency With Volume Overload—Intravenous Loop Diuretic may be Indicated

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

In Hypertensive Urgency With Volume Overload—Intravenous Loop Diuretic may be Indicated

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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