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

Valsartan Dosing for Hypertension in Adults

For adults with hypertension, start valsartan at 80-160 mg once daily and titrate up to a maximum of 320 mg once daily as needed for blood pressure control. 1

Initial Dosing Strategy

• Begin with 80 mg or 160 mg once daily as monotherapy in patients who are not volume-depleted. 1
• Patients requiring greater blood pressure reductions may be started at the higher 160 mg dose. 1
• The antihypertensive effect is substantially present within 2 weeks, with maximal reduction generally attained after 4 weeks. 1

Dose Titration and Optimization

• The optimal dose range for hypertension is 80-160 mg once daily, based on efficacy and tolerability data. 2
• If additional blood pressure reduction is needed beyond the starting dose, increase to a maximum of 320 mg once daily. 1
• Adding a diuretic provides greater blood pressure reduction than dose increases beyond 80 mg. 1
• Clinical studies demonstrate dose-dependent efficacy across the 80-320 mg range, though incremental benefits diminish at higher doses. 3, 2

Combination Therapy Approach

• Combine valsartan with a dihydropyridine calcium channel blocker or thiazide diuretic as first-line therapy for most patients with confirmed hypertension (BP ≥140/90 mmHg). 4
• Fixed-dose single-pill combinations are recommended to improve adherence. 4
• 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. 4

Blood Pressure Targets

• Target treated systolic blood pressure to 120-129 mmHg in most adults to reduce cardiovascular risk. 4
• For patients without comorbidities, target <140/90 mmHg; for those with existing cardiovascular disease or high cardiovascular risk, target <130 mmHg systolic. 4

Administration and Monitoring

• Take valsartan once daily at the most convenient time to establish a habitual pattern and improve adherence. 4
• Follow-up monthly after initiation or dose changes until blood pressure target is reached, then every 3-5 months for patients under control. 4
• Monitor serum potassium and creatinine within 1-2 weeks after initiating or increasing doses, particularly in patients with baseline renal impairment. 4

Critical Safety Considerations

• Do not combine valsartan with an ACE inhibitor, as this increases the risk of hyperkalemia and renal dysfunction. 4
• The tolerability profile of valsartan is excellent, with adverse events similar to placebo across the dose range. 3, 2
• Valsartan 160 mg once daily demonstrates sustained 24-hour AT₁-receptor blockade, while 80 mg provides similar blockade only during the first 6 hours. 5