What is the recommended dose of valsartan (angiotensin II receptor antagonist) for adults with hypertension?

Valsartan Dosing for Hypertension

For adults with hypertension, start valsartan at 80-160 mg once daily, with a maximum dose of 320 mg once daily; most patients achieve optimal blood pressure control at 80-160 mg daily. 1

Initial Dosing Strategy

• Start with 80 mg once daily for most patients, or 160 mg once daily if greater blood pressure reduction is needed 1
• The starting dose should be 80 mg in patients who are not volume-depleted, with 160 mg reserved for those requiring more aggressive initial reduction 1
• The antihypertensive effect becomes substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 1

Dose Titration and Maximum Dosing

• If additional blood pressure lowering is needed beyond the starting dose, increase to a maximum of 320 mg once daily 1
• Valsartan demonstrates dose-dependent efficacy over the range of 80-320 mg daily 1, 2
• However, adding a diuretic provides greater blood pressure reduction than dose increases beyond 80 mg 1

Optimal Dose Range Based on Evidence

• The optimal dose range for essential hypertension is 80-160 mg once daily, balancing efficacy with tolerability 3
• While 160 mg provides sustained AT₁-receptor blockade over 24 hours compared to 80 mg (which shows diminished blockade at 12-24 hours), the incremental blood pressure reduction with doses above 80 mg is relatively small 4, 3
• The 160 mg dose achieves significantly greater AT₁-receptor blockade at 12 and 24 hours compared to 80 mg, though both doses produce similar blockade during the first 6 hours 4

Combination Therapy Considerations

• Valsartan should be combined with a dihydropyridine calcium channel blocker or thiazide diuretic as first-line therapy for most patients with confirmed hypertension (BP ≥140/90 mmHg) 5
• Fixed-dose single-pill combinations are recommended to improve adherence 5
• If blood pressure remains uncontrolled on two-drug combination, escalate to three-drug therapy with a RAS blocker, dihydropyridine calcium channel blocker, and thiazide/thiazide-like diuretic 5

Blood Pressure Targets

• Target treated systolic blood pressure to 120-129 mmHg in most adults to reduce cardiovascular risk 5
• This target should be pursued provided the treatment is well tolerated 5

Common Pitfalls to Avoid

• Do not combine valsartan with an ACE inhibitor, as this increases the risk of hyperkalemia and renal dysfunction 6
• Avoid assuming that higher doses always provide proportionally greater benefit—the dose-response curve flattens above 80 mg for blood pressure reduction 3
• Monitor serum potassium and creatinine within 1-2 weeks after initiating or increasing doses, particularly in patients with baseline renal impairment 6

Administration Timing

• Take valsartan once daily at the most convenient time to establish a habitual pattern and improve adherence 5
• Doses are usually taken upon awakening 2