Valsartan in chronic heart failure.
OBJECTIVE
To evaluate the evidence for valsartan in the treatment of heart failure and determine its need for formulary inclusion.


METHODS
OVID and PubMed databases were searched (1983-June 2004) using the key words angiotensin-receptor blocker, heart failure, valsartan, Diovan, and angiotensin-converting enzyme inhibitor. Only English-language literature was selected.


METHODS
Pharmacology and pharmacokinetic evaluations for valsartan were selected. Prospective, randomized clinical trials investigating the use of valsartan and other angiotensin-receptor blockers (ARBs) in chronic heart failure were evaluated.


RESULTS
Valsartan, a selective antagonist for angiotensin receptor subtype 1, is the first ARB to be approved for use in chronic heart failure. Clinical trial data support valsartan as an alternative to angiotensin-converting enzyme (ACE) inhibitors in ACE inhibitor-intolerant patients with chronic heart failure. Valsartan is generally well tolerated, with renal impairment, elevated serum creatinine and potassium levels, and dizziness being the most common adverse effects; consequently, patients experiencing those adverse events while taking ACE inhibitors are likely to experience them with valsartan. Although further study is needed, differences in effectiveness among races may exist with use of valsartan; however, at this time, valsartan is recommended as an alternative to ACE inhibitors regardless of race. Candesartan and losartan have been studied in similar settings. Candesartan's data support its use in heart failure; however, losartan's data have been less consistent.


CONCLUSIONS
Valsartan is a safe and effective alternative for heart failure patients intolerant of ACE inhibitors. Valsartan has not been shown to be safe and effective when used in combination with ACE inhibitors.
Ripley
Toni L
TL
Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190-5040, USA. toni-ripley@ouhsc.edu
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005572:Formularies, Hospital as Topic; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008107:Liver Diseases / Q000378:metabolism; D008297:Male; D010353:Patient Education as Topic; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000378:metabolism; D013777:Tetrazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000068756:Valsartan
D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine