A vasodilatory antihypertensive drug lowers blood pressure by reducing systemic vascular resistance. Some patients treated with these agents may develop dependent edema.
Factors contributing to edema associated with vasodilating antihypertensive medications:
(1) water retention
(2) arteriolar dilatation with increased intracapillary pressure
(3) stimulation of the renin-angiotensin-aldosterone system
Risk factors for vasodilatory edema:
(1) drug type (see table below)
(2) a higher dose of the causative drug
(3) older age
Risk of Vasdilatory Edema |
Antihypertensive Drugs |
highest |
minoxidil, hydralazine (direct arteriolar dilators) |
|
amlodipine, nifedipine (higher risk dihydropyridine calcium antagonists) |
|
lercanidipine, lacidipine (lower risk dihydropyridine calcium antagonists) |
|
alpha-blocker |
|
anti-adrenergic drugs (beta-blockers) |
lowest |
nondihydropyridine calcium antagonists |
Therapeutic decision-making:
(1) The addition of a diuretic does not reduce vasodilatory edema.
(2) Addition of an angiotension converting enzyme (ACE) inhibitor or angiotensin receptor blocking (ARB) agent to therapy with a dihydropyridine calcium antagonist is associated with less vasodilatory edema than increasing the antagonist's dose.
(3) Addition of a selective blocker of the renin-angiotensin system (such as the ARB valsartan) may reduce vasodilatory edema by dilating venules.
This drug-induced peripheral edema needs to be distinguished from onset or worsening of congestive heart failure.
Purpose: To evaluate a patient with vasodilatory peripheral edema associated with antihypertensive drug therapy.
Objective: adverse effects
ICD-10: I10-I15, T46.7,