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Valsartan: Effect, Dosage and Correct Use in High Blood Pressure
Valsartan is one of the most used blood-pressure lowerers in Germany and belongs to the group of the sartans (angiotensin II receptor blockers). About 30 million people in Germany have high blood pressure (a German figure, broadly comparable across Western countries), many of them treated with sartans. Unlike ACE inhibitors such as ramipril, valsartan as a rule causes no dry cough — but potassium and kidney values have to be checked regularly.
Valsartan is contraindicated in pregnancy - harm to the child is possible. Potassium and kidney values are checked regularly. With angioedema (facial swelling with breathlessness), call the emergency services immediately (112; or 999/112 in the UK). Last updated: May 2026.
1. At a Glance: Technical Data Sheet
Valsartan is one of the most widely used blood-pressure-lowering medicines and the most important representative of the sartan group. Below are the key facts for quick orientation; the individual points are explained in detail in the following chapters.
Property
Details
Active substance
Valsartan - angiotensin II receptor blocker (sartan/ARB)
Blockade of the AT1 receptors - angiotensin II can no longer narrow the vessels; blood pressure falls, aldosterone release reduced
Main indications
High blood pressure, heart failure, after a heart attack, kidney protection in diabetes
Usual dose
80-320 mg/day, once daily
Onset of action
First reduction in days, full effect after 2-4 weeks
Important advantage over ACE inhibitors
No dry irritant cough
Important checks
Potassium and kidney values before the start and over the course
Strictly contraindicated
Pregnancy (harm to the child); combination with ACE inhibitors
Prescription status
Yes
Table scrollable to the right
2. What is valsartan?
Valsartan is a frequently prescribed medicine for lowering blood pressure and for treating heart failure. It belongs to the group of sartans (also called angiotensin II receptor blockers or ARBs). It is known under the trade name Diovan; there are numerous generics and combination products. Valsartan is one of the most widely used blood-pressure medicines of all.
Sartans like valsartan are, alongside the ACE inhibitors, calcium channel blockers (e.g. amlodipine) and diuretics (water tablets), one of the four most important pillars of high-blood-pressure therapy. An important advantage of valsartan over the ACE inhibitors: it as a rule causes no dry irritant cough - a common and bothersome side effect of the ACE inhibitors.
Valsartan is usually well tolerated, but requires attention to a few points: the monitoring of potassium and kidney values, the strict contraindication in pregnancy and the fact that high blood pressure requires long-term therapy. We explain these topics in detail.
3. How does valsartan work pharmacologically?
Valsartan intervenes in the renin-angiotensin-aldosterone system (RAAS) - a central hormone system for the regulation of blood pressure and fluid balance. The decisive actor is the hormone angiotensin II, which strongly narrows the blood vessels and thereby raises the blood pressure. In addition, it promotes the release of aldosterone, which retains water and salt in the body.
Valsartan blocks the receptors on which angiotensin II acts (the AT1 receptors). As a result, the hormone cannot develop its vessel-narrowing effect - the vessels relax and widen, the blood pressure falls. At the same time, less aldosterone is released, which reduces the retention of water and salt.
Pharmacokinetics in brief
Valsartan is absorbed after oral intake and excreted predominantly via the bile/gut (less via the kidneys than some other sartans). The effect lasts a long time, so that the once-daily intake is sufficient. The blood-pressure-lowering effect builds up over about 2 to 4 weeks - the full effect does not show immediately, but after a few weeks.
4. Sartan or ACE inhibitor? The advantage without a dry cough
A practically very important point. Sartans (like valsartan) and ACE inhibitors (like ramipril, enalapril) both intervene in the same hormone system (RAAS) and lower the blood pressure with similar effectiveness. The decisive difference lies in the side-effect profile:
Aspect
Sartans (valsartan)
ACE inhibitors (ramipril)
Mechanism of action
Blockade of the AT1 receptor
Inhibition of angiotensin formation
Blood-pressure lowering
Comparably good
Comparably good
Heart/kidney protection
Comparably good
Comparably good
Dry irritant cough
As a rule not
Common (in a relevant proportion)
Angioedema (swelling)
Very rare
Rare, but more common than sartans
Potassium rise
Possible
Possible (similar)
Combination possible?
NO - no combination with an ACE inhibitor
NO - no combination with sartans
Table scrollable to the right
Sartans are therefore often used when ACE inhibitors are not tolerated because of the cough - or from the outset, when this advantage is wanted. Important: sartans and ACE inhibitors are not combined with each other (no additional benefit, more side effects). The choice is made by the doctor.
5. What is valsartan used for?
High blood pressure (hypertension)
The main indication. In high blood pressure, valsartan lowers the blood pressure and thereby reduces, in the long term, the risk of secondary diseases such as heart attack, stroke, heart failure and kidney damage. It is used alone or in combination with other blood-pressure medicines.
Heart failure
In heart failure, valsartan improves the prognosis and symptoms - it relieves the heart by widening the vessels and reducing the fluid load. It is an established building block of heart-failure therapy.
After a heart attack
After a heart attack with impaired heart function, valsartan can be used to improve the prognosis.
Kidney protection
In certain kidney diseases (especially in diabetes with beginning kidney damage), sartans can protect the kidneys and slow the progression - by lowering the pressure in the kidney vessels.
6. The combination with amlodipine and other substances
High blood pressure can often be treated better with a combination of several substances at a lower dose than with a single one at a high dose - this improves the effect and reduces side effects. Valsartan is therefore available in fixed combination products:
Valsartan + amlodipine (e.g. Exforge): a very common combination. Amlodipine is a calcium channel blocker that widens the vessels by another route - the two complement each other well. Amlodipine can cause ankle oedema, which is partly alleviated by the sartan
Valsartan + hydrochlorothiazide (HCT): a combination with a diuretic (water tablet) - enhances the blood-pressure lowering
A triple combination (valsartan + amlodipine + HCT): with hard-to-control high blood pressure
Valsartan + sacubitril (in heart failure): a special combination product for heart-failure therapy (Entresto)
The advantage of fixed combination products: fewer tablets, better adherence to therapy. The selection is guided by the blood pressure, accompanying diseases and tolerability. The individual components each have their own side-effect profiles, which the doctor takes into account.
7. Dosage and intake
High blood pressure: usually starting with 80 mg/day, increase to 160 mg, up to 320 mg/day if necessary - according to the blood pressure
Heart failure: starting gradually, slowly increasing to the target dose (according to tolerability, blood pressure, kidneys and potassium)
Once daily at about the same time
With or without food possible
Kidney/liver function: dose adjustment if necessary
The most important intake notes
Take regularly and permanently - high blood pressure is usually a long-term therapy
At the same time of day for an even effect
Do not stop on your own - even if the blood pressure is good (it would rise again)
Patience: the full effect only shows after 2-4 weeks
If a dose is forgotten: make it up as soon as possible; if it is almost time for the next, skip it - do not double
Attend blood-pressure self-monitoring and medical check-up appointments
Unlike some other blood-pressure medicines, valsartan usually does not have to be strictly tapered on stopping - nevertheless, stopping should always be discussed with the doctor, as the blood pressure otherwise rises again.
8. Common side effects
Valsartan is usually well tolerated - sartans are among the best-tolerated blood-pressure medicines. Possible side effects:
Dizziness, light-headedness - especially at the start and on standing up (due to the blood-pressure lowering)
Low blood pressure (hypotension) - especially with too high a dose or fluid deficiency
Raised potassium values - its own chapter
A change in the kidney values - its own chapter
Rarely: gastrointestinal complaints, skin rash
An important advantage: unlike ACE inhibitors, valsartan as a rule causes no dry irritant cough. Most side effects are mild and occur mainly at the start. With strong dizziness (especially on standing up), the dose should be reviewed.
9. Keeping an eye on potassium and kidney function
An important safety topic with all RAAS inhibitors (sartans and ACE inhibitors). Since valsartan intervenes in the hormone system that also regulates the potassium and fluid balance as well as the blood flow to the kidneys, regular checks are important:
Potassium
Valsartan can raise the potassium level in the blood (hyperkalaemia). Too high a potassium value can cause dangerous cardiac arrhythmias. The risk rises with impaired kidney function, with combination with other potassium-raising agents (certain diuretics, potassium preparations, salt substitutes with potassium) and with diabetes.
Kidney function
Valsartan influences the blood flow to the kidneys. In most patients this is unproblematic or even kidney-protective; in certain situations (e.g. renal artery narrowing, fluid deficiency), however, the kidney function can worsen. That is why the kidney values are monitored.
Blood checks of potassium and kidney values before the start and over the course (especially after the start of therapy/a dose change)
Caution with combination with potassium-raising agents and with kidney weakness
With fluid deficiency (heavy sweating, diarrhoea, vomiting) caution - a risk of a drop in blood pressure and a burden on the kidneys
Avoid salt substitutes with potassium (often in "diet salts")
Take regular blood checks seriously
The regular blood checks (potassium, kidney values) are part of safe valsartan therapy - especially with impaired kidney function, diabetes and combination with other medicines. Attend the appointments consistently.
10. Valsartan in pregnancy
Valsartan is contraindicated in pregnancy
Especially from the second and third trimester - sartans can severely harm the unborn child (kidneys, skull, lungs) and lead to a lack of amniotic fluid. With a wish to have children or an established pregnancy, valsartan must be stopped and switched to a blood-pressure medicine suitable in pregnancy.
Women of childbearing age should know this and speak with the doctor early when wishing to have children - a timely switch to an agent compatible with pregnancy is important. Valsartan is also as a rule not recommended during breastfeeding; here there are more suitable alternatives. This point is mentioned here as important safety information - the individual advice is given by a doctor.
11. Interactions with other medicines
Substance/category
Effect
Recommendation
Potassium-sparing diuretics (spironolactone, amiloride), potassium preparations, salt substitutes with potassium
Increased hyperkalaemia risk
Caution, potassium checks
ACE inhibitors
More side effects, no additional benefit
Avoid the combination
NSAIDs (ibuprofen, diclofenac and others)
Weaken the blood-pressure-lowering effect; "triple whammy" with diuretics
Avoid, better paracetamol
Lithium
Increased lithium levels possible
Level checks
Other blood-pressure-lowering agents, diuretics
Enhanced blood-pressure lowering (often wanted)
Watch the blood pressure
Certain diabetes medicines
Blood-sugar and potassium changes
Caution, monitoring
Table scrollable to the right
The combination with potassium-raising agents and with NSAIDs in particular is relevant. Before any new medication (including over-the-counter painkillers), consult a doctor/pharmacist. More under Interactions of medicines and Taking medicines correctly.
12. Valsartan and alcohol
On the topic of alcohol, there are a few things to bear in mind with valsartan:
Alcohol can lower the blood pressure - in combination with valsartan, an enhanced drop in blood pressure and dizziness can occur, especially on standing up
Regular, heavier alcohol consumption, on the other hand, raises the blood pressure in the long term - and counteracts the therapy
An increased risk of dizziness/falls due to the combined blood-pressure-lowering effect
Practical recommendation: moderate alcohol consumption is usually possible, but with high blood pressure restraint is generally sensible - because regular alcohol raises the blood pressure. Watch out for enhanced dizziness after alcohol. With high blood pressure, a moderate approach to alcohol is part of the healthy lifestyle that supports the therapy.
13. Understanding and measuring blood pressure correctly
Since valsartan is usually taken permanently against high blood pressure, a basic understanding of blood pressure and self-measurement helps:
Two values: the upper (systolic) and the lower (diastolic) value, in mmHg
Orientation: an optimal in-practice blood pressure is usually around 120/80 mmHg; the individual target values are determined by the doctor (they depend on age and accompanying diseases)
Self-measurement at home: at rest, sitting, after a few minutes' pause, the cuff at heart height; in the morning and evening, document regularly
High blood pressure often causes no symptoms - precisely for that reason, consistent treatment and measurement are so important (a "silent" risk factor)
Document the values - they help the doctor in steering the therapy
Regular blood-pressure self-measurement is a valuable tool for therapy monitoring. Important: high blood pressure is treated to prevent secondary damage (heart attack, stroke, kidney/heart damage) - even if one feels healthy.
14. Valsartan in older people
Well tolerated and frequently used - an important therapy option in old age too
An increased risk of a drop in blood pressure and dizziness on standing up (orthostatic hypotension) - mind the fall risk
Kidney function often limited in old age - closer monitoring of kidney values and potassium
An increased hyperkalaemia risk - especially with combination with potassium-raising agents
Polypharmacy - mind interactions (NSAIDs, diuretics, lithium)
With fluid deficiency (heat, diarrhoea) take particular care
15. When to see a doctor? (Warning signs)
Persistently high blood pressure despite therapy or very low blood pressure with symptoms
Strong dizziness, light-headedness, a tendency to faint (especially on standing up)
Muscle weakness, heart stumbling, fatigue - possible signs of raised potassium values
A markedly reduced urine amount, water retention - possible kidney problems
Swelling of the face, lips, tongue, breathlessness - suspected angioedema (rare, an emergency)
In women: pregnancy or a wish to have children - a switch is needed
Before planned operations - raise valsartan
With strong fluid loss (diarrhoea, vomiting, heat) - consult about a dose adjustment
New medicines (especially NSAIDs, potassium-raising agents) - check interactions
Call the emergency services immediately (112; or 999/112 in the UK)
With swelling of the face/lips/tongue with breathlessness (angioedema - rare, but an emergency), signs of a hypertensive crisis (very high blood pressure with strong headaches, visual disturbances, chest pain, neurological deficits), fainting or signs of severe cardiac arrhythmias (due to very high potassium).
16. What you can do yourself: 10 Golden Rules
Take regularly and permanentlyEven if the blood pressure is good and there are no symptoms.
Measure and document the blood pressure yourselfHelps with steering the therapy - in the morning and evening at rest.
Stand up slowlyAgainst dizziness from a drop in blood pressure.
Attend the blood checksHave potassium and kidney values checked regularly.
NSAIDs only after consultationIbuprofen and others can impair the effect and the kidneys - better paracetamol.
Avoid potassium-rich salt substitutesHave diet salts and potassium preparations clarified by a doctor.
With a wish to have children/pregnancy, switch earlyValsartan is contraindicated in pregnancy.
A healthy lifestyle as a boosterA low-salt diet, exercise, weight management, moderate alcohol, stopping smoking.
With strong fluid loss, consult a doctorDiarrhoea, vomiting, heat - consider a dose adjustment.
Do not stop on your ownAlways discuss with the doctor - the blood pressure would rise again.
17. How brite supports you with valsartan
Transparency notice
brite is a health app. The following functions relate to features of the app and do not replace medical guidance.
Intake reminder: take valsartan reliably every day as a long-term therapy - brite reminds you consistently, important for blood-pressure control.
Interaction check: check NSAIDs, potassium-raising agents, lithium and ACE inhibitors free of charge.
Reminder of check-up appointments: do not forget the regular potassium and kidney-value checks.
Health history: document blood-pressure values and well-being - valuable for medical therapy steering.
Digital medication plan: all medicines clearly laid out for your GP, cardiologist and pharmacy.
Note
Anonymised observations from brite app user data, do not replace clinical studies.
Observation
Frequency
Typical comment
Switch from ramipril to valsartan because of a dry cough
Very common
"After 2 years with ramipril and a constant cough - the switch to valsartan took the cough away within 2 weeks."
Self-directed stopping with "good" values
Common
"I thought I no longer needed the medicine - 4 weeks later the blood pressure was back at 170."
NSAID self-medication - blood pressure rises
Very common
"Ibuprofen daily for knee pain - then the blood pressure was suddenly bad again, my GP recognised the connection."
Dizziness on standing up especially in the morning
Common
"At the start, everything went black on standing up in the morning - with standing up slowly and a sitting pause it improved after 2 weeks."
Hyperkalaemia with a spironolactone combination
Common
"With valsartan and spironolactone together, the potassium was at 5.8 - now only valsartan, the potassium is normal."
Pregnancy - switch to methyldopa
Rare but important
"With a wish to have children I had to stop valsartan - my gynaecologist switched to alpha-methyldopa, which is permitted in pregnancy."
Table scrollable to the right
Valsartan experiences: what patients really ask
Valsartan experiences after a switch from ramipril - is it worth it? With a dry cough under an ACE inhibitor, almost always a clear yes. The dry irritant cough occurs in about 5-20% of ACE-inhibitor users and is one of the most common causes of discontinuation of therapy. What to expect: after the switch, the cough usually disappears within 1-4 weeks (sometimes longer), the blood-pressure control remains comparably good. Important: ACE inhibitors and sartans are not equivalent in every respect - in some high-risk constellations (e.g. after a heart attack with impaired pumping function) there are more study data for ACE inhibitors, but sartans are a very good alternative. Practically: those who cannot bear the cough should raise it - quality of life and adherence rise with a well-tolerated medicine.
The valsartan scandal of 2018 - what happened? An important episode in pharmaceutical legislation. In 2018, in valsartan generics of certain manufacturers (especially from China and India), carcinogenic impurities (NDMA and NDEA) were detected - arising during synthesis. The EMA and BfArM (Germany) ordered extensive recalls. What patients need to know: the production processes have since been revised, tests are strict, newer batches are controlled. The absolute risk from the short-term exposure was assessed as low. Practically today: pharmacists check the batches, the generics produced after 2018 are considered safe. With concerns, alternative sartans (e.g. candesartan, losartan, olmesartan), which were not affected, can be discussed with the doctor.
Valsartan experiences with ankle oedema - does it come from the sartan?Rather not directly - ankle oedema is typical of calcium channel blockers like amlodipine, not of valsartan. But: in the common combination valsartan + amlodipine (Exforge), ankle oedema often occurs through the amlodipine - the sartan even partly alleviates it. If ankle oedema is bothersome: often a reduction of the amlodipine dose with a simultaneous increase of the valsartan helps, a switch to other calcium channel blockers (e.g. lercanidipine, which causes less oedema), or the addition of a diuretic. Important to distinguish: ankle oedema from amlodipine is harmlessly cosmetic, whereas swelling from heart failure or kidney failure is a warning sign - with sudden occurrence or one-sided swelling, have it investigated by a doctor.
Valsartan's effect is wearing off - what to do? Several possible causes. The most common reasons: weight gain (a higher blood-pressure need), increased salt consumption, alcohol, sleep apnoea (very often underdiagnosed!), new pain medication with NSAIDs, an increase in stress, irregularity of intake. Pharmacologically: a genuine weakening of the effect is rare with sartans - rather, a "hidden" problem lies behind it. Diagnostically: a blood-pressure diary over 7-14 days, possibly a 24-hour blood-pressure measurement, an examination for sleep apnoea (snoring, daytime fatigue, overweight), cholesterol and kidney values. Therapeutically: increase the dose (e.g. from 80 to 160 mg), combination with amlodipine or HCT, lifestyle optimisation, treatment of sleep apnoea. Rarely: look for secondary causes of hypertension (e.g. renal artery stenosis, an adrenal tumour).
Valsartan and sex - are there side effects?Compared with other blood-pressure medicines very favourable. While beta blockers and older diuretics frequently cause erectile dysfunction and loss of libido, sartans like valsartan are in this respect neutral or even favourable. Some studies even suggest that sartans can improve sexual function in high-blood-pressure patients - presumably through the lowering of the blood pressure and the improvement of endothelial function. If erectile dysfunction occurs under valsartan: usually look for other causes (diabetes, CHD, overweight, stress, psychological factors), review the medicine combination (beta blockers, diuretics?), a sildenafil combination is usually safely possible. Important: with new erectile dysfunction, have it investigated by a doctor - it can be an early warning sign of cardiovascular disease, not just a medicine side effect.
FAQ: Common questions about valsartan
No - this is an important advantage of valsartan and other sartans: they as a rule cause no dry irritant cough, which is a common and bothersome side effect with ACE inhibitors. Sartans are therefore often used when an ACE inhibitor is not tolerated because of a cough. In blood-pressure lowering and in the protection of the heart and kidneys, both are largely equivalent.
A first lowering of blood pressure sets in within the first days, but the full effect builds up over about 2 to 4 weeks. That is why the blood pressure is only conclusively assessed a few weeks after the start of therapy or a dose change. Patience is important - and the regular, permanent intake, since high blood pressure requires long-term therapy.
Usually yes - high blood pressure is as a rule a chronic illness that requires long-term therapy. If valsartan is stopped, the blood pressure rises again. Even if one feels healthy and the blood pressure is well controlled, the medicine should not be stopped on one's own - because the treatment protects against secondary damage such as heart attack and stroke. Always discuss stopping with the doctor.
Valsartan intervenes in the hormone system that also regulates potassium and the blood flow to the kidneys. It can raise the potassium level (too high potassium can cause dangerous cardiac arrhythmias) and in certain situations influence the kidney function. That is why potassium and kidney values are checked before the start and over the course - especially with kidney weakness, diabetes and combination with potassium-raising agents.
No - valsartan is contraindicated in pregnancy, especially from the second trimester, because it can severely harm the unborn child. With a wish to have children or an established pregnancy, a switch must be made to a blood-pressure medicine compatible with pregnancy. Women of childbearing age should know this and speak with the doctor early when wishing to have children. During breastfeeding too, there are more suitable alternatives.
Valsartan is a sartan (widens the vessels via the hormone system). Amlodipine is a calcium channel blocker (widens the vessels by another route). The fixed combination (e.g. Exforge) unites both - this lowers the blood pressure more than each component alone and can reduce side effects (e.g. the sartan alleviates the ankle oedema caused by amlodipine). Combination products mean fewer tablets and better adherence to therapy.
Only with caution and better after consultation. NSAIDs like ibuprofen can weaken the blood-pressure-lowering effect of valsartan and - especially in combination with a diuretic - worsen the kidney function (a so-called "triple whammy" combination). For occasional pain, paracetamol is often the less problematic choice. Before regular NSAID intake, ask a doctor/pharmacist.
Moderate consumption is usually possible, but restraint is sensible. Alcohol can acutely lower the blood pressure and, in combination with valsartan, enhance dizziness (especially on standing up). Regular, heavier alcohol consumption, on the other hand, raises the blood pressure in the long term and counteracts the therapy. With high blood pressure, moderate alcohol is part of the healthy lifestyle that supports the treatment.
Make up the forgotten dose as soon as you think of it. If it is almost time for the next dose, skip the forgotten one and carry on as normal - do not take a double dose. Since valsartan works for a long time, a single forgotten dose is usually not dramatic, but the regular daily intake is important for the permanent blood-pressure control. A fixed routine and reminders help.
Dizziness and light-headedness can occur especially at the start and on standing up - due to the blood-pressure lowering. Fatigue is possible but rarer. These effects often improve as the body gets used to the lower blood pressure. Helpful: stand up slowly. With strong or persistent dizziness, the dose should be reviewed - the blood pressure may be lowered too much.
Sources
IQWiG (Germany) — gesundheitsinformation.de: high blood pressure, sartans. gesundheitsinformation.de
European guidelines for the management of arterial hypertension (ESC/ESH). escardio.org
German Hypertension League (DHL, Germany) — hypertension. hochdruckliga.de
Drug Commission of the German Medical Association (AkdÄ, Germany) — RAAS inhibitors. akdae.de
Federal Institute for Drugs and Medical Devices (BfArM, Germany) — sartans. bfarm.de
Medical disclaimer: This article serves general information and does not replace medical advice, diagnosis or therapy. Dosages and treatment decisions are always determined individually by the doctor. Valsartan is contraindicated in pregnancy. Potassium and kidney values are monitored. Do not leave high blood pressure untreated or stop the medicine on your own. With swelling of the face/lips/tongue with breathlessness or signs of a hypertensive crisis, call the emergency services immediately (112; or 999/112 in the UK). Last updated: May 2026.
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Valsartan is contraindicated in pregnancy - harm to the child is possible. Potassium and kidney values are checked regularly. With angioedema (facial swelling with breathlessness), call the emergency services immediately (112; or 999/112 in the UK). Last updated: May 2026.
