What is the recommended dose of valsartan (Angiotensin II Receptor Antagonist) for adults with hypertension (High Blood Pressure)?

Valsartan Dosing for Hypertension in Adults

For adults with hypertension, start valsartan at 80-160 mg once daily, with a maximum dose of 320 mg daily if needed for blood pressure control. 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 at initiation. 1
• The antihypertensive effect becomes substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks. 1
• Valsartan should be used as part of combination therapy (preferably as a single-pill combination) with either a thiazide/thiazide-like diuretic or a long-acting dihydropyridine calcium channel blocker to improve adherence and achieve better blood pressure control. 2, 3

Dose Titration and Optimization

• If additional blood pressure reduction is required beyond the starting dose, increase to a maximum of 320 mg once daily, though adding a diuretic provides greater effect than dose increases beyond 80 mg. 1
• The dose-response relationship for valsartan shows predictable increases in antihypertensive efficacy from 80 mg to 160 mg, with the optimal dose range being 80-160 mg once daily. 4, 5
• Doses above 160 mg provide relatively small incremental blood pressure reductions, though doses up to 320 mg remain safe and effective. 6, 5

Blood Pressure Targets

• Target blood pressure should be <140/90 mmHg for patients without comorbidities. 2
• For patients with existing cardiovascular disease, target systolic blood pressure <130 mmHg. 2
• For high-risk patients (those with high cardiovascular risk, diabetes, or chronic kidney disease), consider targeting systolic blood pressure <130 mmHg. 2

Practical Administration

• Administer valsartan once daily at the same time each day to establish a habitual pattern and improve adherence. 3
• Valsartan can be taken with or without food. 6
• Follow up monthly after initiation or dose changes until blood pressure target is reached, then every 3-5 months for patients under control. 2

Important Safety Considerations

• Never combine valsartan with an ACE inhibitor, as this increases risk of hyperkalemia and renal dysfunction. 3
• Monitor serum potassium and creatinine within 1-2 weeks after initiating or increasing doses, particularly in patients with baseline renal impairment. 3
• Use lower starting doses (80 mg) in volume-depleted patients to avoid hypotension. 1
• The tolerability profile of valsartan is comparable to placebo across the dose range, with significantly lower incidence of cough compared to ACE inhibitors. 6, 5

Common Pitfalls to Avoid

• Do not underdose: Many physicians use doses that are too low; ensure titration to at least 160 mg daily if blood pressure remains uncontrolled on 80 mg, before adding additional agents. 4
• Do not delay treatment for extensive testing: Laboratory screening for comorbidities should not delay initiation of antihypertensive therapy. 2
• The incremental benefit of increasing from 160 mg to 320 mg is modest, so adding a second agent from a different class is generally more effective than maximizing valsartan monotherapy beyond 160 mg. 1, 5