From the Guidelines
When switching from Altace (ramipril) 2.5 mg to valsartan, the recommended equivalent starting dose is valsartan 80 mg once daily. This conversion is based on the dose ranges provided in the KDOQI clinical practice guidelines for diabetes and chronic kidney disease 1. Ramipril is an ACE inhibitor with a starting dose of 1.25-2.5 mg daily, while valsartan is an angiotensin II receptor blocker (ARB) with a starting dose of 80 mg daily.
Key Considerations
- The switch should be made directly without overlap, taking the first dose of valsartan when the next dose of ramipril would have been due.
- Blood pressure should be monitored closely during the first 1-2 weeks after switching, as individual responses may vary.
- Dose adjustments may be necessary based on blood pressure readings and tolerability.
Benefits of Switching
- The switch to valsartan might be beneficial for patients experiencing ACE inhibitor-related side effects like cough.
- Both medications work on the renin-angiotensin-aldosterone system to lower blood pressure, which is crucial in managing hypertension and slowing the progression of kidney disease, especially in patients with diabetes or chronic kidney disease 1.
Patient Instructions
- Patients should continue taking their medication at the same time each day.
- Report any unusual side effects to their healthcare provider. It is essential to note that higher levels of blood pressure are associated with more rapid progression of kidney disease, and ACE inhibitors and ARBs are effective in slowing this progression 1. Therefore, maintaining adequate blood pressure control is crucial, and the choice of medication should be based on individual patient needs and responses.
From the Research
Altace to Valsartan Conversion
- Altace, also known as ramipril, is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure 2.
- Valsartan is an angiotensin II receptor blocker (ARB) that is also used to treat high blood pressure and heart failure.
- There is no direct evidence in the provided studies to support a specific conversion ratio from Altace 2.5 mg to valsartan.
- However, studies have compared the effects of ramipril and valsartan in combination with other medications, such as amlodipine and hydrochlorothiazide, on blood pressure and left ventricular hypertrophy 3, 4.
- One study found that the combination of valsartan and hydrochlorothiazide had a greater antihypertensive effect than amlodipine alone 3.
- Another study found that the addition of valsartan to a combination of amlodipine and hydrochlorothiazide was more effective in reducing left ventricular hypertrophy than the addition of ramipril 4.
Key Findings
- Ramipril has been shown to be effective in reducing blood pressure and proteinuria in patients with hypertension and diabetes 5, 2.
- Valsartan has been shown to be effective in reducing blood pressure and left ventricular hypertrophy in patients with hypertension and diabetes 3, 4.
- The combination of valsartan and hydrochlorothiazide has been shown to be more effective than amlodipine alone in reducing blood pressure 3.
- The addition of valsartan to a combination of amlodipine and hydrochlorothiazide has been shown to be more effective than the addition of ramipril in reducing left ventricular hypertrophy 4.