Valsartan vs beta blockers
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Valsartan vs Beta Blockers in Hypertension and Heart Failure
Heart Failure Treatment: Valsartan, Beta Blockers, and Combination Therapy
In patients with heart failure with reduced ejection fraction (HFrEF), both beta blockers and valsartan (an angiotensin receptor blocker, ARB) are established therapies that improve symptoms and reduce mortality. Beta blockers were among the first drugs shown to reduce mortality in heart failure, followed by ACE inhibitors and ARBs like valsartan . More recently, sacubitril/valsartan, a combination of an ARB and a neprilysin inhibitor, has shown even greater benefits in reducing death and hospitalizations compared to enalapril, an ACE inhibitor 5679.
When sacubitril/valsartan is used, it is effective in reducing the risk of death and heart failure hospitalizations regardless of whether patients are also taking a beta blocker. However, the benefit may be even greater in patients not on beta blockers, especially for reducing all-cause and cardiovascular death . Current guidelines recommend using sacubitril/valsartan together with beta blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors as the primary therapy for HFrEF, replacing the older approach of starting one drug at a time .
Valsartan and Beta Blockers in Hypertension Management
For hypertension, beta blockers are not usually recommended as first-line therapy due to their lower effectiveness in preventing stroke compared to other drug classes. However, they are often used in combination with other antihypertensive agents. A large study comparing amlodipine plus bisoprolol (a beta blocker) versus amlodipine plus valsartan found no significant difference in all-cause death, atherosclerotic cardiovascular events, or heart failure between the two groups. However, the combination with bisoprolol was associated with a lower risk of hemorrhagic stroke .
Effects on Heart Structure and Function
Valsartan has been shown to improve left ventricular structure and function in heart failure patients, especially when added to standard therapy that includes either an ACE inhibitor or a beta blocker. However, in patients already taking both an ACE inhibitor and a beta blocker, adding valsartan did not provide additional benefit for heart structure or function . Similarly, in a large trial, valsartan reduced hospitalizations and improved symptoms in heart failure, but in patients already on both an ACE inhibitor and a beta blocker, there was a concern about potential adverse effects when all three drugs were combined .
Safety and Drug Combinations
The safety profiles of valsartan and beta blockers are generally favorable, and combining them does not appear to increase adverse effects significantly 12. Fixed-dose combinations of beta blockers and ARBs, such as nebivolol/valsartan, are now available for hypertension, offering convenience and potentially improved adherence .
Conclusion
Both valsartan and beta blockers are important in the management of heart failure and hypertension. In heart failure, the combination of sacubitril/valsartan with beta blockers is now the standard of care, providing significant reductions in mortality and hospitalizations. In hypertension, combinations of valsartan or beta blockers with other agents are effective, with some differences in stroke prevention. The choice between valsartan and beta blockers, or their combination, should be guided by the specific clinical scenario, patient characteristics, and current guideline recommendations 12356789.
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