What Angiotensin Receptor Blocker (ARB) has a higher dose than losartan (Cozaar) 100 mg?

From the Guidelines

Valsartan at a dose of 320 mg has a higher dose than losartan (Cozaar) 100 mg. According to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1, Valsartan has a target dose of 320 mg, which is higher than the 100 mg dose of losartan. Other ARBs such as Irbesartan with a target dose of 300 mg also have higher doses than losartan.

• Key points to consider when choosing an ARB include:
  • The target dose of the medication
  • The patient's renal function and potential for hyperkalemia
  • The presence of other medications that may interact with the ARB
  • The patient's history of angioedema or other allergic reactions
• When switching from losartan to another ARB, it is essential to monitor blood pressure and kidney function closely, especially in patients with renal impairment or those on other medications affecting blood pressure 1.
• The increased dose of Valsartan or Irbesartan may provide greater blood pressure reduction compared to losartan, but it is crucial to weigh the potential benefits against the risks of adverse effects, such as hyperkalemia or acute renal failure 1.

From the Research

Angiotensin Receptor Blockers (ARBs) with Higher Doses than Losartan 100 mg

• Valsartan 160 mg and 320 mg have been shown to reduce systolic blood pressure (SBP) and diastolic blood pressure (DBP) more than losartan 100 mg 2
• Valsartan 160 mg and 320 mg induce a dose-dependent blockade of AT(1) receptors, with effects comparable to those of irbesartan 150 mg and candesartan 8 mg at 4 hours 3
• Candesartan has been found to reduce DBP more than valsartan and losartan, with an Emax (maximal effect at an infinitely large dose) of 7.5 mmHg for candesartan, compared to 5.6 mmHg for losartan and 5.8 mmHg for valsartan 4
• Telmisartan has been shown to have a greater antihypertensive effect than losartan, with a significant reduction in home systolic BP and diastolic BP 5
• Irbesartan 300 mg, valsartan 160 mg, and olmesartan 20 mg have been compared to losartan 100 mg, with irbesartan and olmesartan showing a more complete blockade of AT1 receptors in the vasculature and kidney 6

Key Findings

• Valsartan 160 mg and 320 mg have a higher dose and greater antihypertensive effect than losartan 100 mg
• Candesartan and telmisartan have been found to have a greater antihypertensive effect than losartan
• Irbesartan and olmesartan have been shown to induce a more complete blockade of AT1 receptors in the vasculature and kidney than losartan 2, 3, 4, 5, 6