Valsartan is an angiotensin II receptor blocker (ARB) used to treat hypertension, heart failure, and post-myocardial infarction (MI) ventricular dysfunction. It works by selectively inhibiting the binding of angiotensin II to AT1 receptors in vascular smooth muscle and adrenal glands. This prevents vasoconstriction and aldosterone release, leading to lower blood pressure, reduced cardiac afterload, and improved outcomes in chronic heart failure. Unlike ACE inhibitors, ARBs do not increase bradykinin levels, so valsartan causes less cough and angioedema, although these effects can still occur rarely.
Clinical trials such as VALIANT and PARADIGM-HF have established valsartan’s role in cardiovascular disease management. In VALIANT, valsartan was non-inferior to captopril post-MI for mortality reduction. In PARADIGM-HF, sacubitril/valsartan outperformed enalapril in reducing mortality and hospitalisations in heart failure with reduced ejection fraction (HFrEF). Valsartan remains a cornerstone in hypertension therapy, often combined with other antihypertensives (e.g., thiazide diuretics, calcium channel blockers) for additive effects.
Valsartan is well absorbed orally (bioavailability ~25%), with peak plasma concentrations at 2–4 hours. It is highly protein bound and eliminated largely unchanged in bile. Half-life is 6–9 hours, allowing once or twice daily dosing. No dose adjustment is required in mild–moderate renal impairment, but caution is needed in severe impairment or biliary obstruction. The drug’s safety and efficacy profile is favourable, making it widely prescribed across Europe and globally.
Patients should combine treatment with lifestyle changes: diet low in sodium and saturated fat, regular exercise, weight control, and avoidance of tobacco/alcohol excess.
Valsartan is generally well tolerated, but side effects occur, particularly in those with comorbidities or polypharmacy.
Monitoring blood pressure, electrolytes, and kidney function is key to safe therapy.
Patients should be educated about recognising symptoms of hypotension, hyperkalaemia (palpitations, muscle weakness), and angioedema (facial/lip swelling, breathing difficulty).
Valsartan’s interaction profile is mostly pharmacodynamic (blood pressure, potassium, kidney function). However, significant interactions should be considered.
Always review patient’s full medication list including OTC and herbal supplements.
Missed dose: Take as soon as remembered unless close to the next dose; in that case, skip and continue regular schedule. Do not double dose.
Accidental double dose: May cause dizziness, hypotension, or fainting. Lie down, rise slowly, and seek medical advice if symptoms persist.
Large overdose: Can cause pronounced hypotension, shock, or kidney failure. Emergency management includes placing patient supine, IV fluids, vasopressors if needed, monitoring renal function/electrolytes. Haemodialysis is unlikely to remove valsartan effectively due to high protein binding.
Patients should be reminded never to change dose or stop treatment without consulting their clinician, even if they feel well.
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