Water pills and elderly mother's blood pressure, how long can she go though this?

My mom's situation is very similar. She's just shy of 86, has CHF and is on Bumex currently (she was taking Lasix, but it began to "fail" in her doctor's words, so they switched). If her edema increases she adds Metolazone. She also suffers from very low BP.
My impression from her cardiologist is, while low BP is a concern, the real danger to long term diuretics is loss of kidney function. But I think this "dance" our moms are doing can last quite some time. The last time we saw her cardiologist (before the quarantine) he had mentioned if she started to retain fluid, he was going to discuss some sort of device permanently placed to reduce the fluid build up around her lungs (which is where she first starts to collect fluid). He said it would greatly increase her quality of life - but the downside it there's a risk it might shorten the time she has left (my impression is there is a tube that is permanently placed in the sac around her lungs to drain - kind of like a catheter, maybe? - and it's a pathway to possible infection).
You might want to ask her doctors/hospice about switching to Bumex; my mom can take a lower dose, and it seems to control the edema a bit better. She is additionally on Spirolactone (sp?), with the Metolazone "as needed" 2-3 times a week.
Be very careful about the diuretics. When my mom first made the switch, she was so badly swollen that her legs developed ulcerations from the pressure. The Bumex dried her out so efficiently she ended up in the hospital for dehydration. So they were giving her IV fluids for rehydration and Lasix to keep her from retaining fluid. It seemed counter-productive to me at the time, but they were able to get her back on an even keel, so to speak.
Prayers for you and your mom at this time!

This is a Catch 22 situation. If your mother can weigh every day keep a log and note how much weight she has gained (fluid weight from retention from CHF). When she gains 3 lbs over her ideal weight give the water pill & of course monitor her closely for low BP.

Ask her hospice nurse’s advise and discuss the above plan with her as everyone is different.

End Stage CHF can linger indefinitely which may be one of the conditions she is already on hospice for. Her routine of gaining fluid weight and then given water pills to take off the fluid places a great effort on her heart.

Try to limit her sodium intake if she is still eating. Sodium is the worse enemy of CHF and many cardiac conditions but especially CHF.

No one has a crystal ball of course, regarding how long this can go on but from my experience an indefinite time unless something acute occurs that changes everything.

That's kind of crazy. I'm surprised they let her BP get so low! I would think they'd keep a better eye on it and cut back on the lasix BEFORE her BP tanks. 40 mg seems like a lot. I would ask about giving her a lesser amount and maybe that would help end the roller coaster. For example, if the 40 mg were cut to 20 mg, maybe that would be enough to keep the edema under control WITHOUT dropping her BP so crazy low.

Also, since she is on hospice, wondering which way keeps her more comfortable. Getting rid of the fluid or keeping her BP up? I really think they can strike a better balance.

Good luck.

Ask them if they have considered trying a different diuretic. Different types affect people differently, and there are other available besides Furosemide (Lasix). They obviously are open to the idea because they introduced the metazolone in combination with the Lasix; so perhaps it would be worth trying another.

I hope they will be able to help her and make her more comfortable. Best wishes to you both.