"Dec. 18, 2012 -- People who can't get their high blood pressure down with drugs may be helped by a new procedure that deactivates overactive nerves in the kidneys, a small study shows.
The procedure is already available in Europe and "...
Diovan HCT (valsartan and hydrochlorothiazide, USP) is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes, including hydrochlorothiazide and the ARB class to which valsartan principally belongs. There are no controlled trials demonstrating risk reduction with Diovan HCT.
Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).
Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.
Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.
Diovan HCT may be used in patients whose blood pressure is not adequately controlled on monotherapy.
Diovan HCT may be substituted for the titrated components.
Diovan HCT may be used as initial therapy in patients who are likely to need multiple drugs to achieve blood pressure goals.
The choice of Diovan HCT as initial therapy for hypertension should be based on an assessment of potential benefits and risks.
Patients with stage 2 hypertension are at a relatively high risk for cardiovascular events (such as strokes, heart attacks, and heart failure), kidney failure, and vision problems, so prompt treatment is clinically relevant. The decision to use a combination as initial therapy should be individualized and should be shaped by considerations such as baseline blood pressure, the target goal and the incremental likelihood of achieving goal with a combination compared to monotherapy. Individual blood pressure goals may vary based upon the patient's risk.
Data from the high dose multifactorial trial [see Clinical Studies] provides estimates of the probability of reaching a target blood pressure with Diovan HCT compared to valsartan or hydrochlorothiazide monotherapy. The figures below provide estimates of the likelihood of achieving systolic or diastolic blood pressure control with Diovan HCT 320/25 mg, based upon baseline systolic or diastolic blood pressure. The curve of each treatment group was estimated by logistic regression modeling. The estimated likelihood at the right tail of each curve is less reliable due to small numbers of subjects with high baseline blood pressures.
Figure 1: Probability of Achieving Systolic Blood
Pressure < 140 mmHg at Week 8
Figure 2: Probability of Achieving Diastolic Blood
Pressure < 90 mmHg at Week 8
Figure 3: Probability of Achieving Systolic Blood
Pressure < 130 mmHg at Week 8
Figure 4: Probability of Achieving Diastolic Blood
Pressure < 80 mmHg at Week 8
For example, a patient with a baseline blood pressure of 160/100 mmHg has about a 41% likelihood of achieving a goal of < 140 mmHg (systolic) and 60% likelihood of achieving < 90 mmHg (diastolic) on valsartan alone and the likelihood of achieving these goals on HCTZ alone is about 50% (systolic) or 57% (diastolic). The likelihood of achieving these goals on Diovan HCT rises to about 84% (systolic) or 80% (diastolic). The likelihood of achieving these goals on placebo is about 23% (systolic) or 36% (diastolic).
DOSAGE AND ADMINISTRATION
The usual starting dose is Diovan HCT 160/12.5 mg once daily. The dosage can be increased after 1 to 2 weeks of therapy to a maximum of one 320/25 tablet once daily as needed to control blood pressure [see Clinical Studies]. Maximum antihypertensive effects are attained within 2 to 4 weeks after a change in dose.
A patient whose blood pressure is not adequately controlled with valsartan (or another ARB) alone or hydrochlorothiazide alone may be switched to combination therapy with Diovan HCT.
A patient who experiences dose-limiting adverse reactions on either component alone may be switched to Diovan HCT containing a lower dose of that component in combination with the other to achieve similar blood pressure reductions. The clinical response to Diovan HCT should be subsequently evaluated and if blood pressure remains uncontrolled after 3 to 4 weeks of therapy, the dose may be titrated up to a maximum of 320/25 mg.
Diovan HCT may be substituted for the titrated components.
Diovan HCT is not recommended as initial therapy in patients with intravascular volume depletion [see WARNINGS AND PRECAUTIONS].
Use with Other Antihypertensive Drugs
Diovan HCT may be administered with other antihypertensive agents.
Dosage Forms And Strengths
80/12.5 mg tablets, imprinted CG/HGH (Side 1/Side 2)
160/12.5 mg tablets, imprinted CG/HHH
160/25 mg tablets, imprinted NVR/HXH
320/12.5 mg tablets, imprinted NVR/HIL
320/25 mg tablets, imprinted NVR/CTI
Storage And Handling
Diovan HCT (valsartan and hydrochlorothiazide, USP) is available as non-scored tablets containing valsartan/hydrochlorothiazide 80/12.5 mg, 160/12.5 mg, 160/25 mg, 320/12.5 mg and 320/25 mg. Strengths are available as follows.
80/12.5 mg Tablet - Light orange, ovaloid with slightly convex faces debossed CG on one side and HGH on the other side.
Bottles of 90............................NDC 0078-0314-34
Bottles of 14,000.....................NDC 0078-0314-33
Unit Dose (blister pack).......... NDC 0078-0314-06 Box of 100 (strips of 10)
160/12.5 mg Tablet - Dark red, ovaloid with slightly convex faces debossed CG on one side and HHH on the other side.
Bottles of 90
Bottles of 7,000.......................NDC 0078-0315-17
Unit Dose (blister pack)........... NDC 0078-0315-06
Box of 100 (strips of 10) Unit Dose (blister pack of 30) .................. NDC 0078-0315-15
160/25 mg Tablet - Brown orange, ovaloid with slightly convex faces debossed NVR on one side and HXH on the other side.
Bottles of 90
Bottles of 7,000.........................NDC 0078-0383-17
Unit Dose (blister pack)............ NDC 0078-0383-06
Box of 100 (strips of 10) Unit Dose (blister pack of 30) .................... NDC 0078-0383-15
320/12.5 mg Tablet - Pink, ovaloid with beveled edge, debossed NVR on one side and HIL on the other side.
Bottles of 90 ............................
Bottles of 3,500.........................NDC 0078-0471-11
Unit Dose (blister pack)............ NDC 0078-0471-06
Box of 100 (strips of 10) Unit Dose (blister pack of 30) ...................... NDC 0078-0471-15
320/25 mg Tablet - Yellow, ovaloid with beveled edge, debossed NVR on one side and CTI on the other side.
Bottles of 90
Bottles of 3,500.........................NDC 0078-0472-11
Unit Dose (blister pack)............ NDC 0078-0472-06
Box of 100 (strips of 10) Unit Dose (blister pack of 30) ....................... NDC 0078-0472-15
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].
Protect from moisture.
Dispense in tight container (USP).
Distributed by: Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936. Revised: 10/2012
Last reviewed on RxList: 10/16/2012
This monograph has been modified to include the generic and brand name in many instances.
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