What is the equivalent dose of Valsartan (angiotensin II receptor antagonist) for a patient taking Lisinopril (angiotensin-converting enzyme inhibitor) 20mg?

From the Guidelines

The equivalent dose of Valsartan for a patient taking Lisinopril 20mg would be approximately 160mg daily. When switching from an ACE inhibitor like Lisinopril to an ARB like Valsartan, this dose conversion provides similar blood pressure lowering effects, as suggested by the doses listed in Table 28 of the study by 1. Patients should start Valsartan after a 24-hour washout period from the last Lisinopril dose to avoid potential overlapping effects.

Key Considerations

• While both medications work on the renin-angiotensin-aldosterone system, they do so through different mechanisms - Lisinopril blocks the conversion of angiotensin I to angiotensin II, while Valsartan blocks angiotensin II receptors directly.
• This difference explains why some patients who experience ACE inhibitor-related cough may tolerate ARBs better, as noted in the context of managing hypertension and kidney disease 1.
• Blood pressure should be monitored closely after switching medications, as individual responses vary and dose adjustments may be necessary.
• Kidney function and potassium levels should also be checked within 1-2 weeks of making this medication change, considering the importance of these factors in patients with kidney disease, as highlighted by 1.

Clinical Context

• The decision to switch from Lisinopril to Valsartan should be based on individual patient factors, including side effects, efficacy, and comorbid conditions.
• The goal of therapy is to achieve optimal blood pressure control while minimizing adverse effects, as emphasized by the guidelines for managing hypertension in patients with diabetes and chronic kidney disease 1.
• Regular follow-up and monitoring are crucial to ensure that the chosen therapy is effective and well-tolerated.

From the FDA Drug Label

In controlled trials, the antihypertensive effect of once-daily valsartan 80 mg was similar to that of once-daily enalapril 20 mg or once-daily lisinopril 10 mg.

The equivalent dose of Valsartan for a patient taking Lisinopril 20mg is approximately 160mg of Valsartan, as the antihypertensive effect of once-daily Lisinopril 10mg is similar to that of once-daily Valsartan 80mg, and doubling the dose of Lisinopril would likely require doubling the dose of Valsartan to achieve a similar effect 2.

• Key points:
  • Lisinopril 10mg is equivalent to Valsartan 80mg
  • Doubling the dose of Lisinopril to 20mg would likely require doubling the dose of Valsartan to 160mg
  • This is based on the comparison of the antihypertensive effects of these medications in controlled trials 2

From the Research

Equivalent Dose of Valsartan for Lisinopril 20mg

To determine the equivalent dose of Valsartan for a patient taking Lisinopril 20mg, we need to consider the studies that compared the efficacy and tolerability of these two medications.

• The study 3 compared the efficacy, safety, and tolerability of Valsartan to Lisinopril in patients with mild-to-moderate essential hypertension. The results showed that Valsartan 80 mg daily, with titration to 160 mg daily as required, provides similar antihypertensive efficacy to Lisinopril 10 mg daily with titration to 20 mg daily.
• Another study 4 compared the risk-benefit profile of Valsartan with that of Lisinopril in patients with mild to severe hypertension. The results showed that Valsartan 160 mg and Lisinopril 20 mg were similarly effective in reducing sitting blood pressure, with mean reductions of 31.2/15.9 mm Hg and 31.4/15.9 mm Hg, respectively.

Equivalent Dose

Based on these studies, the equivalent dose of Valsartan for Lisinopril 20mg is approximately 160 mg of Valsartan.

• The study 3 suggests that Valsartan 160 mg daily is equivalent to Lisinopril 20 mg daily in terms of antihypertensive efficacy.
• The study 4 also supports this equivalent dose, as Valsartan 160 mg and Lisinopril 20 mg were shown to have similar efficacy in reducing sitting blood pressure.

Tolerability and Efficacy

Both Valsartan and Lisinopril are effective in reducing blood pressure, but Valsartan may have a better tolerability profile, with a lower incidence of cough and other adverse events 3, 4.

• The study 4 showed that Valsartan was associated with a significantly reduced risk of adverse events, especially cough, compared to Lisinopril.
• The study 5 also demonstrated that the combination of Amlodipine and Valsartan was well tolerated and efficacious in patients with stage 2 hypertension.

It is essential to note that individual responses to medication may vary, and the equivalent dose of Valsartan for Lisinopril 20mg may need to be adjusted based on patient-specific factors, such as age, sex, and renal function.