This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Valsartan belongs to angiotensin II receptor antagonists, mainly by antagonizing angiotensin II receptors, dilating arteries and venous vessels, reducing aldosterone release, promoting water and sodium excretion, and playing a hypotensive role, lowering blood pressure without affecting heart rate, antihypertensive effect can be maintained for more than 24 hours, in addition, valsartan can also reverse left ventricular hypertrophy, anti-atherosclerosis, inhibit vascular fibrosis, has a clear cardiovascular protective effect, and can inhibit urine protein excretion, protect the kidneys, and improve the body's sensitivity to insulin, It is the first-line drug for the initial and maintenance of hypertensive patients, especially for hypertensive patients with obesity, coronary heart disease, cardiac insufficiency, diabetic nephropathy, proteinuria or microproteinuria, and left ventricular hypertrophy.
In order to improve the blood pressure attainment rate, most patients with hypertension need to use 2 or more antihypertensive drugs, and the general blood pressure is 160 100mmHg for patients with grade 2 or above 2 hypertension, and 2 kinds of antihypertensive drugs should be used initially, if the blood pressure is higher than 140 90mmHg, the initial blood pressure can also be used in small doses of two antihypertensive drugs, valsartan and which antihypertensive drugs are used in combination? Today, Pharmacist Sun will come to talk about it in detail for you:
1.Horizontal: Horizontal: Horizontals, such as nifedipine, amlodipine, can directly dilate arterial blood vessels, valsartan can dilate both arterial blood vessels and venous blood vessels, therefore, the two drugs can synergistically lower blood pressure, significantly improve the control rate of blood pressure, in addition, horizon antihypertensive drugs can activate the sympathetic nervous system, causing reflex heart rate to increase, valsartan can partially block sympathetic nerve activation, does not affect heart rate. Horizon antihypertensive drugs can cause lower limb edema, valsartan can dilate the capillaries, reduce capillary pressure, reduce or offset lower limb edema, therefore, the combined application of valsartan and horizon antihypertensive drugs can enhance the antihypertensive effect, cancel each other's adverse reactions, and enhance the protection of target organs, which is the preferentially recommended antihypertensive combination in China's hypertension guidelines.
2.Thiazide diuretics: thiazide diuretics such as hydrochlorothiazide, combined with valsartan can further enhance the antihypertensive effect and play a synergistic antihypertensive effect, in addition, hydrochlorothiazide can activate the sympathetic nervous system at the same time when lowering blood pressure, thus producing an effect that is not conducive to blood pressure stability, and valsartan can inhibit sympathetic overactivation and offset this negative effect. In addition, valsartan can inhibit aldosterone secretion and cause an increase in serum potassium, thus effectively preventing hypokalemia that may result from long-term use of hydrochlorothiazide. Therefore, the combination of valsartan and hydrochlorothiazide can enhance the antihypertensive effect, reduce adverse reactions, and enhance the protection of target organs, and is also the combination drug regimen recommended by hypertension guidelines in China.
3.Receptor blockers: -Receptor blockers such as metoprolol, bisoprolol, etc., and valsartan all act on the renin-angiotensin-aldosterone system, and the antihypertensive mechanism is partially overlapped, which cannot significantly increase the antihypertensive effect, therefore, the combination of -receptor blockers and valsartan should be used as a second-line combination regimen.
4.Pulip: Pulp antihypertensive drugs such as benazepril, enalapril, petopril, etc. have a similar mechanism of action to valsartan, and the combined use of antihypertensive effect does not increase significantly, but it can increase the risk of hyperkalemia, and there is no synergistic effect on the protection of the heart and kidneys.
Valsartan has so many advantages that today we will learn about its disadvantages:
1.Valsartan has a high plasma protein binding rate and a long tissue half-life, therefore, the antihypertensive effect is slow, and it usually takes 3-4 weeks to achieve the maximum antihypertensive effect.
2.Valsartan dilates glomerular effluent arterioles more strongly than dilated glomerular affinating arterioles, thereby causing glomerular filtration dysfunction, resulting in increased serum creatinine and serum potassium, for patients with renal insufficiency, serum creatinine and serum potassium levels should be closely monitored in the initial stage, such as serum creatinine higher than 265umol l and/or serum potassium higher than 55 mmol L, the dose should be reduced, monitoring should be continued, and the drug should be discontinued if necessary.
3.Valsartan has reproductive toxicity, which can lead to oligohydramnios and even spontaneous abortion in pregnant women, which can lead to fetal growth retardation, skeletal malformations, renal insufficiency, pulmonary hypoplasia, patent ductus arteriosus, and even death.