What is the recommended dose of Valsartan for a patient with hypertension?

Valsartan Dosing for Blood Pressure 158/101 mmHg

Start valsartan 160 mg once daily and titrate to 320 mg once daily if blood pressure remains uncontrolled after 2-4 weeks, or add hydrochlorothiazide for faster control. 1

Initial Dosing Strategy

Your patient has Stage 2 hypertension (158/101 mmHg) and requires prompt blood pressure reduction.

• Start with valsartan 160 mg once daily as the initial dose for patients requiring greater blood pressure reductions 1
• The 80 mg starting dose is reserved for volume-depleted patients or those at lower cardiovascular risk 1
• The antihypertensive effect becomes substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks 1

Titration to Target Dose

The target dose of valsartan for hypertension is 160 mg twice daily (320 mg total daily dose). 2

• If blood pressure remains ≥140/90 mmHg after 2-4 weeks on valsartan 160 mg once daily, increase to 320 mg once daily 1
• Valsartan may be used over a dose range of 80-320 mg daily, administered once daily 1
• The maximum dose studied is 320 mg once daily for hypertension 1

Combination Therapy for Faster Control

For Stage 2 hypertension like your patient's, combination therapy achieves blood pressure goals significantly faster than monotherapy. 3

• Adding hydrochlorothiazide 12.5-25 mg to valsartan has a greater antihypertensive effect than dose increases beyond 80 mg 1
• With valsartan 160 mg/HCTZ combination, median time to blood pressure goal is 2.6 weeks versus 8.1 weeks with valsartan 160 mg alone 3
• With valsartan 320 mg/HCTZ combination, 75.8% of Stage 2 patients reached blood pressure goal by Week 8 3
• The European Society of Cardiology recommends combining valsartan with a dihydropyridine calcium channel blocker or thiazide diuretic as first-line therapy for most patients with confirmed hypertension 4

Blood Pressure Targets

Target blood pressure to <130/80 mmHg for most patients, or <140/90 mmHg for those without cardiovascular disease or high cardiovascular risk. 4

• For high-risk patients (diabetes, chronic kidney disease, existing cardiovascular disease), target systolic blood pressure <130 mmHg 4
• The American Heart Association recommends <140/90 mmHg for patients without comorbidities 4

Monitoring and Follow-Up

• Measure blood pressure before each clinic visit and follow up monthly after initiation or dose changes until target is reached 4
• Once controlled, follow up every 3-5 months 4
• Monitor serum potassium and creatinine within 1-2 weeks after initiating or increasing doses, particularly in patients with baseline renal impairment 4

Administration Timing

• Take valsartan once daily at the most convenient time to establish a habitual pattern and improve adherence 4
• Doses are usually taken upon awakening 5

Common Pitfalls to Avoid

• Do not combine valsartan with an ACE inhibitor, as this increases the risk of hyperkalemia and renal dysfunction 4
• Do not delay treatment for extensive laboratory testing; screening for comorbidities should not delay initiation of antihypertensive therapy 4
• Do not underdose—studies show that higher doses (160-320 mg) achieve blood pressure goals more frequently and promptly with a favorable benefit-risk profile 3