Valsartan is a medication primarily prescribed to manage high blood pressure (hypertension), heart failure, and to improve survival after a heart attack. It belongs to a class of drugs known as angiotensin II receptor blockers (ARBs). While its main function revolves around cardiovascular health, some studies and side effects have sparked interest in its potential relationship with weight. This article explores the connection between valsartan and weight loss, examining its mechanisms, clinical findings, and potential implications.
What is Valsartan?
Valsartan is an angiotensin II receptor blocker (ARB). It functions by blocking a substance in the body that causes blood vessels to tighten. By relaxing blood vessels, valsartan lowers blood pressure, which in turn increases the supply of blood and oxygen to the heart. It is available only with a doctor's prescription in both solution and tablet forms. Valsartan is used alone or with other medicines to treat high blood pressure. High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks. Valsartan is also used to treat heart failure and left ventricular failure after a heart attack. Left ventricular failure occurs when the left side of the heart (the main pumping chamber) becomes stiff and enlarged or swollen, causing pooling of blood in the lungs because the heart is not pumping properly.
How Valsartan Works
Valsartan functions by blocking the binding of angiotensin II to the AT1 receptor in various tissues, such as those of the blood vessels and adrenal gland. Angiotensin II is a powerful vasoconstrictor (narrows blood vessels) that is also involved in the synthesis and release of aldosterone (the main steroid hormone produced by the adrenal glands).
Valsartan Uses
Valsartan is used to treat high blood pressure in adults and children 6 years and older (generic valsartan), or adults and children 1 year and older (Diovan brand). By lowering high blood pressure, valsartan reduces the risk of a heart attack or stroke. It is also used to reduce the risk of hospitalization in adults with heart failure (NYHA class II-IV stages). Also used post-myocardial infarction (after a heart attack) to reduce the risk of cardiovascular death in stable patients with heart dysfunction. For children with hypertension, Diovan tablets may be added to an oral suspending vehicle to make a liquid suspension. Valsartan is available as tablets and an oral solution.
Hypertension and Obesity: An Intertwined Relationship
Hypertension, or high blood pressure, is frequently associated with obesity. Overweight or obese individuals are more prone to developing hypertension, creating a complex interplay between these two health conditions. Studies have shown a significant correlation between body mass index (BMI) and blood pressure levels.
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The Study in Bologna, Italy
One open-label study conducted in Bologna, Italy, examined the effects of valsartan on overweight or obese outpatients aged 18 to <70 years with previously treated or untreated mild to moderate essential hypertension. Patients were treated with valsartan capsules at a fixed dosage of 80 mg once daily for 8 weeks. The dosage was increased to 160 mg once daily if, at 8 weeks, diastolic blood pressure (DBP) was not normalized; otherwise, the 80-mg/d dosage was maintained. Treatment was continued for an additional 16 weeks. Patients' heart rate, systolic blood pressure (SBP) and DBP, body mass index (BMI), and waist-hip ratio (WHR) were measured/calculated at baseline (week 0) and 8, 16, and 24 weeks. In the 45 patients (93.8%) who completed the study, mean SBP, DBP, and BMI were significantly decreased compared with baseline (all P < 0.001), but WHR was significantly increased (P < 0.05). After 24 weeks of treatment, 71.1 % of patients had SBP/DBP ≤ 140/≤90 mm Hg.
Implications of the Study
The results of this study suggest that valsartan treatment can lead to a significant decrease in BMI among hypertensive patients who are overweight or obese. This indicates a potential benefit of valsartan in managing weight alongside blood pressure.
Weight Gain as a Side Effect
While the study mentioned above indicates a potential for weight loss or BMI reduction, it's essential to acknowledge that weight gain has also been reported as a side effect of valsartan. This apparent contradiction highlights the complexity of how drugs can affect individuals differently.
Valsartan and Lifestyle Recommendations
Valsartan is usually used in addition to other drugs to lower blood pressure, and all lifestyle recommendations given to you by your doctor (such as losing weight if overweight, smoking cessation, partaking in regular exercise, and limiting sodium intake) should also be followed.
The Role of Adipose Tissue
Adipose tissue, commonly known as body fat, is a central focus in studies evaluating mechanisms involved in obesity-related diseases. It is primarily divided into two types of fat depots with different biological functions known as white adipose tissue (WAT) and brown adipose tissue (BAT). However, a third and novel type of adipose tissue has been recently discovered and deemed as bright/beige adipocytes. Exactly, beige adipocyte is brown-like cell that appears in WAT store. WAT is primary site for lipid storage and mobilization, while BAT is thermogenic tissue responsible for heat production. Maintenance the balance between WAT and BAT are crucial to preserve energy homeostasis, while the accumulation of WAT leads to cardiovascular and metabolic disease complications. In some experimental studies it has been shown that promotion of brown fat function or acquisition of BAT characteristics in WAT (terms referred as “browning”) can be protective against obesity and associated metabolic diseases. While WAT distribution highly contributes to increased risk of metabolic diseases, BAT possesses adipocytes that use glucose and FFA as fuel indicating that this type of adipose tissue is in negative correlation with body fat percentage, body mass index, blood glucose levels and diabetes status in a opposite manner to WAT.
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Valsartan and the Potential for "Browning"
A novel combination drug, sacubitril/valsartan, has been shown to be more efficient in reducing cardiovascular events and heart failure readmission compared to conventional therapy. Also, this combination of drugs increases the postprandial lipid oxidation contributing to energy expenditure, promotes lipolysis in adipocytes and reduces body weight.
Cold Exposure and BAT
Amongst numerous established environmental influences on BAT activity, cold exposure is the best interested technique due to its not only effects on of BAT depots in proliferation process but also de novo differentiation of precursor cells via β-adrenergic receptor activation.
Other Side Effects of Valsartan
Like all medications, valsartan can cause side effects. These can range from mild to severe and may include:
- Dizziness or lightheadedness
- Headache
- Fatigue
- Diarrhea
- Joint or muscle pain
More serious side effects that require immediate medical attention include:
- Allergic reactions (angioedema)
- Kidney problems
- High potassium levels (hyperkalemia)
- Low blood pressure (hypotension)
- Vision changes
It is important to note that hair loss is a common side effect of Valsartan.Valsartan may cause eye problems. These problems can occur within hours or weeks of starting the drug, and it is important to talk to a doctor about blurred vision, eye pain, and other vision changes, since these eye problems can lead to vision loss.
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Valsartan Drug Interactions
Medicines that interact with valsartan may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with valsartan. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed. People taking oral medications for diabetes may need to talk to their doctor about adjusting the dose of their medicine.
Valsartan Precautions
In addition to using this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these is most important for you. You should check with your doctor before changing your diet. Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You might have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning. If you faint, call your doctor right away. Check with your doctor right away if you become sick while taking this medicine, especially if you have severe nausea, vomiting, or diarrhea that does not stop. These conditions may cause you to lose too much water and lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.
Valsartan Recall and Carcinogenic Concerns
In 2018, the FDA issued recalls of several types of generic Valsartan due to contamination with carcinogenic substances, specifically N-nitrosodiethylamine (NDEA) and N-nitrosodimethylamine (NDMA). These substances are linked to factories in China that assist with supplying Valsartan to generic drug makers. Not every Valsartan drug contains these carcinogens; sometimes they are introduced through the manufacturing process.