What is the recommended dose and frequency of Valsartan (Angiotensin II receptor antagonist) for treating hypertension?

Valsartan Dosing and Administration for Hypertension

For hypertension treatment, valsartan should be initiated at 80-160 mg once daily and can be titrated up to a maximum of 320 mg once daily, with the antihypertensive effect becoming substantially present within 2 weeks and maximal reduction generally achieved after 4 weeks. 1

Initial Dosing

• Starting dose: 80 mg or 160 mg once daily for patients who are not volume-depleted 1
• Lower starting dose (40 mg) may be appropriate for:
  • Elderly patients (≥75 years) 2
  • Patients with renal impairment (eGFR <30 mL/min/1.73m²) 2
  • Patients with moderate hepatic impairment 2

Dose Titration

• Dose can be increased after 2-4 weeks if additional blood pressure reduction is needed 1
• Titration sequence: 80 mg → 160 mg → 320 mg once daily 1
• The antihypertensive effect is substantially present within 2 weeks and maximal reduction is generally attained after 4 weeks 1

Target Dosing

• Target dose range: 160-320 mg once daily 2
• For uncomplicated hypertension, 160 mg appears to be the optimal dose based on efficacy/tolerability profile 3
• Time to achieve blood pressure goal varies by dose:
  • Valsartan 160 mg: median 8.1 weeks
  • Valsartan 320 mg: median 6.1 weeks 4

Administration Considerations

• Valsartan can be administered once daily 1
• Can be taken with or without food
• If a dose is missed, it should be taken as soon as possible, unless it's almost time for the next dose (do not double dose) 1
• For patients requiring greater BP reduction, adding a diuretic may be more effective than increasing valsartan dose beyond 80 mg 1

Special Populations

• Heart Failure: Different dosing regimen applies:

  • Starting dose: 40 mg twice daily
  • Target dose: 160 mg twice daily 2, 1
  • Maximum daily dose: 320 mg in divided doses 1

• Post-Myocardial Infarction:

  • Starting dose: 20 mg twice daily
  • Uptitrate within 7 days to 40 mg twice daily
  • Target maintenance dose: 160 mg twice daily 1

Monitoring

• Check renal function and serum electrolytes before starting treatment 2
• Re-check renal function and electrolytes within 1 week of starting treatment 2
• Monitor for hypotension, especially in volume-depleted patients 2
• Monitor for hyperkalemia, particularly when used with ACE inhibitors or potassium-sparing diuretics 2

Clinical Pearls

• Valsartan 160 mg provides sustained AT₁-receptor blockade over 24 hours, while 80 mg may not provide complete 24-hour coverage 5
• The 320 mg dose may be associated with a slightly higher incidence of dizziness (9.3%) compared to lower doses (2.1-3.4%) 6
• When switching from an ACE inhibitor to valsartan, no washout period is required (unlike when switching from ACE inhibitor to sacubitril/valsartan) 2
• Avoid the combination of valsartan with ACE inhibitors and aldosterone antagonists as this triple combination may be harmful 7

By following these dosing recommendations and monitoring parameters, valsartan can effectively control blood pressure while maintaining a favorable safety profile.