Valsartan

How it works

It selectively antagonises the angiotensin II type 1 (AT1) receptor, blocking angiotensin II-mediated vasoconstriction and aldosterone release to reduce blood pressure and cardiac afterload.

Prescribing in practice

• Contraindicated in pregnancy and should be stopped if pregnancy is planned or confirmed, as ARBs are foetotoxic in the second and third trimesters.
• Avoid combining with an ACE inhibitor or aliskiren because dual renin-angiotensin blockade increases the risk of hyperkalaemia, hypotension and renal impairment.
• Use cautiously in renal artery stenosis, volume depletion, and severe heart failure where renal function depends on the renin-angiotensin system.

Monitoring

Monitor blood pressure, renal function and serum potassium before starting and after dose changes.

Counselling the patient

• Report planned or suspected pregnancy promptly so the medicine can be reviewed.
• Rise slowly from sitting or lying, especially with the first doses, to limit dizziness.
• Avoid potassium-containing salt substitutes unless advised otherwise.

Evidence & guidelines

NICE recommends ARBs such as valsartan as alternatives to ACE inhibitors for hypertension and heart failure, and the Val-HeFT and VALIANT trials support its use in heart failure and post-infarction LV dysfunction.