# Two-Drug Combinations Therapy of Different Doses of Valsartan Existing Diverse Significance for Hypertensive Patients

## TL;DR

This study evaluates how combining high-dose valsartan with other drugs affects blood pressure and side effects in hypertension patients.

## Contribution

The study identifies optimal drug combinations with high-dose valsartan for effective blood pressure control without significant adverse effects.

## Key findings

- Combining valsartan 320 mg with amlodipine 10 mg showed the best antihypertensive effect with minimal adverse effects.
- High-dose valsartan combined with hydrochlorothiazide 25 mg did not further reduce blood pressure or increase adverse effects.
- Combination therapy with high-dose valsartan effectively controls blood pressure and clinical complications.

## Abstract

The incidence of hypertension and clinical complications
(e.g., heart, cerebrovascular and kidney injury) is increasing worldwide. It is
widely known that a relatively large dose of valsartan (320 mg) could alleviate
clinical complications. The current network meta-analysis assessed which drug
could be combined with a relatively large dose of valsartan to control blood
pressure (BP) more effectively. And which combination therapy with different
dosages of valsartan did not induce excessive BP reduction with increasing
dosages of valsartan.

The PubMed, Embase, Medline, Cochrane
Library, CNKI, Wanfang, and CSTJ databases were searched from inception to
October 2022 for relevant randomized controlled trials (RCTs). The search
strategies included concepts related to hypertension and two-drug combination
therapy of different doses of valsartan, and there were no language or data
restrictions. The outcomes included adverse effects and changes in systolic BP
and diastolic BP. Permanent discontinuations related to treatment were the most
accurate and objective measure of adverse effects. The common adverse effects of
most studies (i.e., dizziness, headache, nasopharyngitis, asthenia and urticaria)
were also included. A Bayesian network meta-analysis was performed, and mean
differences with 95% confidence intervals were calculated. ADDIS and STATA were
used for Bayesian model network meta-calculation.

Thirty-four
RCTs were included involving 26,752 patients, and the interventions included
different doses of valsartan combined with various types and doses of drugs.
Among many combination therapies, the combination of valsartan 320 mg with
amlodipine 10 mg (p
< 0.01) had the best antihypertensive effect
without significant adverse effects. Compared with valsartan 80 mg and 160 mg,
valsartan 320 mg combined with hydrochlorothiazide 25 mg (p
> 0.05)
did not further reduce BP and was not shown to increase the incidence of adverse
effects.

Combination therapy with a relatively large dose
of valsartan could control BP and improve clinical complications effectively.
However, for hypertensive patients with different treatment requirements,
specific choices should be made regarding whether to control BP, treat clinical
complications, or both.