Adverse cardiovascular and blood pressure effects of drug-induced hypomagnesemia

ABSTRACT

Introduction: The objective of this study was to review the current status of drug-induced hypomagnesemia and its adverse effects on cardiovascular disease (CVD) and hypertension. Since magnesium is a potent vasodilator, which modulates vasomotor tone, peripheral blood flow, and hypertension, its deficiency could have significant cardiovascular and blood pressure (BP) effects.

Areas covered: Studies have shown that several factors can contribute to magnesium deficiency including age, diet, disease, and certain drugs such as diuretics and proton-pump inhibitors (PPIs). For an updated perspective of drug-induced hypomagnesemia, a Medline search of the English language literature was conducted between 2010 and 2019 using the terms diuretics, proton-pump inhibitors, hypomagnesemia, cardiovascular disease, hypertension, and 35 pertinent papers were retrieved.

Expert opinion: The data showed that magnesium deficiency is difficult to occur since it is plentiful in green leafy vegetables, cereals, nuts, and the drinking water. However, magnesium deficiency can occur with the use of diuretics for the treatment of hypertension and heart failure, or the use of PPIs for the treatment of gastroesophageal reflux disease. Therefore, magnesium deficiency should be detected and treated to prevent the aggravation of hypertension and the onset of CVD and serious cardiac arrhythmias including torsades de points.

KEYWORDS:

• Hypomagnesemia
• drugs
• diuretics
• proton-pump inhibitors
• hypertension
• arrhythmias

Article highlights

• The incidence of diuretic-induced hypomagnesemia is currently low due to the use of low dose diuretics and their combination with potassium-sparing agents.

• The PPI-induced hypomagnesemia has been recently discovered, but its incidence is low compared to the large number of subjects taking these drugs.

• Magnesium deficiency can also occur from certain diseases, dietetic factors and low magnesium content of drinking water.

• Whatever its cause, magnesium deficiency is associated with increased incidence of hypertension, CVD, and serious cardiac arrhythmias.

• Medical vigilance is required for its early diagnosis and treatment.

This box summarizes key points contained in the article.

Acknowledgments

The authors would like to thank the INTEGRIS Baptist Medical Center librarian Lisa Marie Zarrella for her help in retrieving some of the papers used in this review.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.