From the FDA Drug Label
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 patient with uncontrolled hypertension taking Enalapril 10mg can be switched to Valsartan, considering the similar antihypertensive effects of both drugs at different dosages.
- Key points:
- Valsartan 80mg has a similar antihypertensive effect to Enalapril 20mg.
- The patient is currently taking Enalapril 10mg, which is half the dose used in the comparison.
- The switch to Valsartan may require dose adjustment to achieve optimal blood pressure control. 1
From the Research
Yes, a patient with uncontrolled hypertension taking Enalapril 10mg can be switched to Valsartan, but this should be done carefully with appropriate dosing and monitoring. The decision to switch from Enalapril to Valsartan should be based on the individual patient's response to treatment and potential side effects. According to a study published in 1997 2, Valsartan was found to be as effective as Enalapril in reducing blood pressure in patients with essential hypertension.
Key Considerations for Switching
- The typical starting dose of Valsartan for hypertension is 80-160mg once daily, with a maximum dose of 320mg daily.
- When switching, it's essential to discontinue Enalapril for 24 hours before starting Valsartan to avoid potential overlapping effects.
- Blood pressure should be monitored closely during the transition period, especially in the first two weeks.
- Both medications work on the renin-angiotensin-aldosterone system but through different mechanisms - Enalapril blocks the conversion of angiotensin I to angiotensin II, while Valsartan blocks angiotensin II receptors directly.
Benefits and Precautions
- This switch might be beneficial for patients experiencing ACE inhibitor-related side effects like persistent dry cough or angioedema.
- However, both medications carry similar precautions regarding kidney function, potassium levels, and pregnancy risks, so these parameters should continue to be monitored after the switch.
- A study from 2007 3 found that higher doses of Valsartan monotherapy or Valsartan combination therapy achieved blood pressure control more frequently and promptly, with a favorable benefit-risk profile.
- Another study from 2009 4 highlighted the effectiveness of Valsartan in a broad range of patients and the importance of managing patient- and physician-level determinants to optimize blood pressure outcomes.
Recent Evidence
- A more recent study from 2018 5 compared sacubitril/valsartan with Enalapril in patients with heart failure, providing insights into the safety, tolerability, and efficacy of sacubitril/valsartan in a different patient population.
- While this study does not directly address the switch from Enalapril to Valsartan in hypertension management, it underscores the importance of careful patient selection and monitoring when initiating or switching therapies that affect the renin-angiotensin-aldosterone system.