What is the use of Valsartan (Angiotensin II receptor antagonist)?

From the Guidelines

Valsartan is recommended as a first-line treatment for patients with heart failure with reduced ejection fraction (HFrEF) who are intolerant to ACE inhibitors, with a typical starting dose of 40 mg twice daily and gradual increase as needed, as supported by the 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure 1.

Key Points

• Valsartan is an angiotensin II receptor blocker (ARB) medication used to treat high blood pressure, heart failure, and improve survival after heart attacks.
• The medication works by blocking the action of angiotensin II, allowing blood vessels to relax and widen, which lowers blood pressure and reduces strain on the heart.
• Common side effects include dizziness, headache, and occasional cough, though ARBs generally cause fewer coughs than ACE inhibitors.
• Valsartan should be taken consistently, with or without food, and patients should avoid potassium supplements and salt substitutes containing potassium while using this medication.
• It's contraindicated during pregnancy as it can cause fetal harm, and caution is needed in patients with kidney disease or those taking other medications that affect kidney function.

Dosage and Administration

• The typical starting dose is 80-160 mg once daily, which can be increased to a maximum of 320 mg daily if needed.
• For heart failure, treatment usually begins at 40 mg twice daily and is gradually increased.

Clinical Evidence

• The VALIANT trial found valsartan to be noninferior to captopril, although it did not show superiority 1.
• The Valsartan Heart Failure Trial (Val-HeFT) assessed the efficacy of valsartan at doses up to 320 mg/d added to standard therapy for reducing morbidity and mortality in patients with HF, demonstrating a 13.2% reduction in the combined end point of cardiovascular mortality and morbidity compared with patients receiving placebo 1.
• The CHARM-Added trial showed that patients with stable LV dysfunction benefited from the combination of an ACE inhibitor and the ARB candesartan 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Valsartan Overview

• Valsartan is an angiotensin II-receptor blocker (ARB) used to treat hypertension, heart failure, or both 2.
• The optimal daily dose of valsartan has been assessed in patients with hypertension, heart failure, or both, with studies suggesting that 160 mg may be the optimal dose for initial therapy in patients with essential hypertension and in most patients with heart failure 2.

Efficacy and Tolerability

• The antihypertensive effect of valsartan increases in a predictable fashion over a wide dose range (20-320 mg) 2.
• The antihypertensive efficacy of the 80-mg dose is enhanced by doubling it to 160 mg, with a tolerability profile comparable to that of placebo over a broad dose range 2.
• Valsartan has been investigated in patients with heart failure at dosages ranging from 40 to 160 mg BID, with careful individualization of therapy needed in these patients 2.

Cardio-Cerebrovascular Disease Risk

• A study comparing the risk of cardio-cerebrovascular disease between ARBs of different half-lives found that valsartan use was associated with a higher risk of myocardial infarction (MI) but a lower risk of cerebrovascular disease compared to telmisartan use 3.
• The adjusted hazard ratio (aHR) for MI was higher for valsartan use (1.39,1.33-1.45) and losartan use (1.10,1.05-1.15) but lower for irbesartan use (0.90,0.86-0.94) compared to telmisartan use 3.
• The aHR for cerebrovascular disease was lower for valsartan use (0.85,0.83-0.87) and losartan use (0.80,0.78-0.82) but higher for irbesartan use (1.11,1.09-1.13) compared to telmisartan use 3.