Valsartan/Hydrochlorothiazide is Effective in Hypertensive Patients Inadequately Controlled by Valsartan Monotherapy

Effectiveness and safety of high-dose valsartan monotherapy in hypertension treatment: the ValTop study

“…16 Obviously, the size of additional BP-lowering effect Table 4 Number (%) of patients with most frequently reported (X0.2% in either group) adverse events that were suspected to be related to administration of study drug (safety population, double-blind phase) achieved by doubling valsartan dose was smaller compared with what was observed when hydrochlorothiazide or amlodipine were added to valsartan. [17][18][19] However, the aim of our study was not to undermine the usefulness of combination therapy in achieving BP control, but rather to show that, in a number of subjects, using the same ARB as a high-dose monotherapy may be sufficient to achieve the therapeutic target. Although the BP changes observed in ValTop are in line with the dose-response curve described in other studies, 14,15 ValTop provides a deeper insight into the characteristics of response to increasing dosages of valsartan.…”

Improving Blood Pressure Control: Increase the Dose of Diuretic or Switch to a Fixed‐Dose Angiotensin Receptor Blocker/Diuretic? The Valsartan Hydrochlorothiazide Diuretic for Initial Control and Titration to Achieve Optimal Therapeutic Effect (Val‐DICTATE) Trial

“…Because these changes were both clinically and statistically greater than the monotherapy components and occurred without excessive adverse events, it led to the approval of the fixed-dose combination valsartan/hCtZ used in the present study. in another study, by Mallion and coworkers, 19 in 2002 patients whose Bp was inadequately controlled with valsartan 160 mg, valsartan/hCtZ 160/12.5 mg induced a 4/2-mm hg greater reduction in Bp than monotherapy, with an absolute rate of response of 65% compared with 50% with valsartan monotherapy. in a trial similar in concept to that of Mallion and associates, 19 rosenstock and colleagues 20 evaluated the antihypertensive efficacy and safety of adding the arB irbesartan to hCtZ in patients whose Bp was not adequately controlled by hCtZ alone.…”

“…in another study, by Mallion and coworkers, 19 in 2002 patients whose Bp was inadequately controlled with valsartan 160 mg, valsartan/hCtZ 160/12.5 mg induced a 4/2-mm hg greater reduction in Bp than monotherapy, with an absolute rate of response of 65% compared with 50% with valsartan monotherapy. in a trial similar in concept to that of Mallion and associates, 19 rosenstock and colleagues 20 evaluated the antihypertensive efficacy and safety of adding the arB irbesartan to hCtZ in patients whose Bp was not adequately controlled by hCtZ alone. in this study, however, the background drug was hCtZ 25 mg/d rather than the arB.…”

“…several fixeddose combination therapies of arBs as well as aCEis and diuretics have been used for the treatment of hypertension and have demonstrated a greater degree of Bp lowering than either medication alone. 15,[18][19][20][21] for example, in a large study by Benz and associates 15 involving 871 patients, reductions in Bp with use of valsartan and hCtZ at doses of 160 and 12.5 mg, respectively, lowered Bp 16/9 mm hg more than placebo, compared with 10/5 mm hg with valsartan 160 mg alone and 5/3 mm hg with hCtZ alone. Because these changes were both clinically and statistically greater than the monotherapy components and occurred without excessive adverse events, it led to the approval of the fixed-dose combination valsartan/hCtZ used in the present study.…”

Management of cardiovascular risk with RAS inhibitor/CCB combination therapy

“…54,56 However, combining a CCB with a RAS blocker may offer enhanced BP control without the metabolic effects often associated with diuretics. There is also evidence that combining either an ACEI or an ARB with a DHP-CCB may reduce the incidence of ankle oedema, the most common adverse effect of DHPCCBs.…”