This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Valsartan, irbesartan and telmisartan are all commonly used first-line antihypertensive drugs in clinical practice, which belong to angiotensin II receptor antagonists, mainly acting on the renin-angiotensin-aldosterone system, and by antagonizing angiotensin II and AT1 receptors, it reduces vascular resistance and aldosterone secretion and plays a hypotensive role. In addition, these drugs can simultaneously dilate arteries and veins, reduce peripheral vascular resistance or afterload, reduce pulmonary capillary impotence or preload, and also reduce pulmonary vascular resistance, thereby improving cardiac output, increasing exercise tolerance, and prolonging time. Finally, these drugs also have the effect of reversing left ventricular hypertrophy and renal protection, promoting urinary sodium excretion, improving insulin resistance, significantly reducing proteinuria, and delaying the progression of end-stage renal disease. Clinically, it is mainly suitable for hypertension, left ventricular hypertrophy, heart failure, diabetic nephropathy, proteinuria, etc.
Adverse effects of valsartan are:
Common: headache, dizziness.
Less common: cough, diarrhoea, fatigue, rhinitis, back pain, nausea, pharyngitis, viral infections, upper respiratory tract infections, and arthralgia.
Rarely: decreased hemoglobin and hematocrit, with an incidence of neutropenia of 18%。
Valsartan** hypertension 80 mg once a day, can be increased to 160 mg once a day after 2-4 weeks, as appropriate. The maintenance dose is 80 to 160 mg once a day. **Heart failure starts at 40 mg twice daily and gradually increases to 80 mg twice daily or 160 mg twice daily, as tolerated. Diet has no significant effect on the absorption and efficacy of valsartan, and it can be taken on an empty stomach or after meals, and it is recommended to take it on an empty stomach at 7 in the morning. Patients with heart failure who have hyponatremia and/or volume depletion should be corrected before taking valsartan. For older people, patients with renal insufficiency, non-biliary cirrhosis, or bile duct obstruction do not need to adjust the dose. It is recommended to avoid potassium supplements and potassium-rich foods during medication.
Adverse effects of irbesartan are:
Common: dizziness, nausea, flushing, musculoskeletal injuries, etc.
Less common: diarrhoea, dyspepsia, orthostatic hypotension.
Rare: cough and allergic reactions (rash, urticaria, angioedema).
The initial and maintenance dose of irbesartan is 150 mg once a day, and if blood pressure is not effectively controlled, the dose can be increased to 300 mg once, or other antihypertensive drugs such as diuretics (hydrochlorothiazide) may be added. For patients undergoing hemodialysis and over 75 years of age, the initial dose is 75 mg once a day. Patients with renal insufficiency and mild to moderate hepatic impairment do not need to adjust the dose. Irbesartan can be taken with or without food, and it is recommended to take it on an empty stomach at 7 a.m. to improve medication compliance.
Adverse effects of telmisartan are:
Common: nausea, dizziness, diarrhea.
Less common: upper respiratory tract infection, urinary tract infection, rash, itching, back pain, tinnitus.
Rarely: asthma, angioedema.
Telmisartan 40 to 80 mg once a day can be combined with thiazide diuretics such as hydrochlorothiazide. Patients with mild to moderate renal insufficiency do not need to adjust the dose when taking it. For patients with mild to moderate hepatic insufficiency, the daily dosage should not exceed 40mg, and it should be used under close monitoring. 80 mg a day for patients with high-risk cardiovascular disease. In combination with diuretics, it is advisable to start with a low dose (40 mg). For those who are on diuretics**, discontinue diuretics for 2 to 3 days before starting the drug, except for severe or malignant hypertension, in which case telmisartan should be started at a low dose and carefully increased under observation. Telmisartan can cause vertigo, and patients should avoid activities that require coordination, such as driving or manipulating machinery, until the drug has taken effect. Telmisartan can cause orthostatic hypotension, and patients are advised to move slowly when changing from sitting or recumbent position. Long-term users should avoid abrupt discontinuation.