How to choose valsartan and valsartan combined with hydrochlorothiazide?😵😵😵

Valsartan and hydrochlorothiazide tablets are commonly used clinically combined preparations. Clinically, what is the difference between valsartan hydrochlorothiazide and valsartan? Which one should I choose? How to use valsartan and hydrochlorothiazide correctly?

1. How to use valsartan and hydrochlorothiazide tablet?

Currently, there is only one dose of valsartan and hydrochlorothiazide tablets (80mg/12.5mg), each containing 80mg of valsartan and 12.5mg of hydrochlorothiazide.

Dosage: One tablet each time, once a day. The maximum antihypertensive effect can be achieved within 2 to 4 weeks of taking the medicine. According to the efficacy of the drug, the dosage can be adjusted every 1 to 2 weeks.

Because hydrochlorothiazide can cause hyperuricemia, hyperlipidemia and hyperglycemia. They are related to the dosage. If the blood pressure still fails to reach the target after 4 weeks, the patient should not increase the dosage without authorization, and adjust the medication regimen under the guidance of the doctor. Food does not affect the absorption of hydrochlorothiazide. Although food can significantly reduce the absorption of valsartan, valsartan can be taken with or without food. In order to reduce blood pressure fluctuations, patients should take the medication at a fixed time, either before or after meal. For most patients, in order to avoid increased nocturia, it is recommended to take it in the morning.

2. The combination of valsartan and hydrochlorothiazide can exert the effect of 1+1>2.

Complementary mechanisms to reduce blood pressure:

Valsartan belongs to angiotensin II receptor antagonist. It can block the effect of angiotensin II. Angiotensin II is one of the important active ingredients of the renin-angiotensin-aldosterone system. It binds to specific receptors on cell membranes of various tissues and exerts different physiological effects, including direct or indirect regulation of blood pressure. Angiotensin II is a strong vasoconstrictor substance. It can exert a direct effect of raising blood pressure. It can also promote the reabsorption of sodium and stimulate the secretion of aldosterone. In addition, valsartan is a specific angiotensin II receptor antagonist. It does not inhibit angiotensin converting enzyme. This enzyme converts angiotensin I into angiotensin II and degrades bradykinin. The retention of bradykinin can cause coughing. Therefore, valsartan does not cause coughing.

Hydrochlorothiazide excretes natriuresis and diuresis. It can reduce blood volume. At the same time enhance plasma renin activity. This stimulates the production of angiotensin I and II. Hydrochlorothiazide mainly acts on the proximal end of the distal convoluted tubule. It inhibits sodium chloride transport at the proximal end of the distal convoluted tubule and inhibits the cotransport of sodium and chloride ions. This directly increases the excretion of sodium and chlorine, and indirectly reduces blood volume. Then increase plasma renin activity, aldosterone secretion and potassium excretion. This lowers the blood potassium concentration. Renin-angiotensin-aldosterone system is depending on angiotensin II. Combination with angiotensin II receptor antagonists can reduce blood potassium loss associated with thiazide diuretics.

Reduce the incidence of hypokalemia:

Hydrochlorothiazide promotes sodium and potassium ion exchange and aldosterone secretion. This increases the excretion of potassium ions, which can cause hypokalemia.

Valsartan inhibits the release of aldosterone mediated by angiotensin II and reduces potassium excretion, which can reduce the risk of hydrochlorothiazide-related hypokalemia.

3. How to choose valsartan or valsartan combined with hydrochlorothiazide?

For blood pressure less than 160/100mmHg, valsartan can be used.

Patients with blood pressure ≥160/100mmHg or higher than the target blood pressure of 20/10mmHg should prefer valsartan and hydrochlorothiazide.

People who are allergic to sulfanilamide drugs should not use valsartan and hydrochlorothiazide tablets. Patients with hyperuricemia and hypercalcemia should avoid valsartan and hydrochlorothiazide tablets.

4. Precautions for valsartan and hydrochlorothiazide tablets.

Valsartan and hydrochlorothiazide tablets can still cause hypokalemia:

In addition to hypokalemia, hydrochlorothiazide can also cause hypomagnesemia, hyponatremia and so on. Therefore, electrolyte levels should be monitored regularly during medication.

When combined with calcium supplements and vitamin D, valsartan and hydrochlorothiazide tablets should be used with caution:

Thiazide diuretics can reduce calcium secretion and increase blood calcium levels. During medication, if calcium supplements and/or vitamin D are used, serum calcium levels should be monitored. If it is necessary, adjust the dosage of calcium supplements and vitamin D.

Hydrochlorothiazide can cause photosensitivity rashes, moss-like reactions, and lupus erythematosus. Patients should avoid exposure to the sun during medication. Hydrochlorothiazide can reduce glucose tolerance. Patients with latent diabetes mellitus may have symptoms. Therefore, diabetics may need to adjust the dose of hypoglycemic drugs.