- Systematic Reviews can Define the Boundaries of What is and is Not Known
- Systematic Reviews can Help Practitioners Solve Specific Clinical Problems
- Investigators need Systematic Reviews to Summarize Existing Data, Refine
Hypotheses, Estimate Sample Sizes, and Help Define Future Research Agendas
Ann Pharmacotherapy 2004 39: 460-469
Ripley, T. L.
OBJECTIVE: To evaluate the evidence for valsartan in the treatment of heart failure and determine its need
for formulary inclusion.
DATA SOURCES: 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.
STUDY SELECTION AND DATA EXTRACTION: 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.
DATA SYNTHESIS: 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.
Results favor Valsartan as
an alternative drug in
ACE inhibitor intolerant
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