Valsartan vs. Diltiazem

See how Valsartan and Diltiazem compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Valsartan is an ARB taken once daily for high blood pressure, heart failure, and after a heart attack, while diltiazem is a calcium channel blocker also used for angina and heart rhythm control.

  • Diltiazem can slow the heart rate and is not safe for people with certain conduction problems, while valsartan does not affect heart rate or cardiac conduction.

  • Both drugs lower blood pressure well, but diltiazem also treats angina and atrial fibrillation, while valsartan is also approved for heart failure and post-heart-attack care.

Valsartan vs. Diltiazem Drug Summary

Valsartan

Valsartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure, heart failure, and to help protect the heart after a heart attack. It works by relaxing blood vessels so the heart doesn't have to work as hard. It's taken as a single tablet once a day, usually starting at 80 mg.

Diltiazem

Diltiazem is a non-dihydropyridine calcium channel blocker used to treat high blood pressure, chronic and vasospastic angina, and to control heart rate in atrial fibrillation or flutter. It comes in immediate-release, sustained-release, and extended-release oral forms, plus an IV form for urgent rate control. For hypertension, it's usually taken as one extended-release capsule daily.

Valsartan vs. Diltiazem Side Effects

Valsartan

Most common
Dizziness (up to 14%)
Fatigue (up to 2%)
Headache (up to 14%)
Viral infection (up to 3%)

Diltiazem

Most common
Dizziness (up to 6.4%)
Fatigue (up to 4.8%)
Bradycardia (up to 3.6%)
Cough (up to 2%)

Valsartan vs. Diltiazem Dosage

Valsartan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 80 mg once daily At the start
Maximum dose Up to 320 mg daily If needed
Dose changes 2 increases As tolerated

Diltiazem

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.25 mg/kg IV bolus At the start
Maximum dose 480 mg once daily If needed
Dose changes 7 increases As tolerated

Valsartan vs. Diltiazem Indications

Valsartan

Valsartan is an ARB approved to lower blood pressure in adults and children 6 and older. It's also approved for heart failure (NYHA class II-IV) to reduce hospitalizations, and for adults with heart damage after a heart attack to lower the risk of death.

  • Hypertension in adults and children 6 and up

  • Heart failure, NYHA class II-IV

  • Post-heart-attack care for reduced heart function

  • Often combined with other blood pressure drugs

Diltiazem

Diltiazem is a calcium channel blocker approved for hypertension, chronic stable angina, and vasospastic (Prinzmetal's) angina. It's also approved to control heart rate in atrial fibrillation or flutter and to treat paroxysmal supraventricular tachycardia (PSVT), usually by IV in urgent settings. Doctors sometimes also use it off-label for migraine prevention or Raynaud's phenomenon.

  • Hypertension, usually with extended-release capsules

  • Chronic stable and vasospastic angina

  • Rate control in atrial fibrillation or flutter

  • PSVT, treated with IV diltiazem

Valsartan vs. Diltiazem Pros and Cons

Valsartan

Valsartan is generally well tolerated and doesn't slow the heart rate or affect its electrical conduction. Because it acts on the kidneys and potassium balance, people with heart failure need periodic blood tests to check kidney function.

Pros

  • Doesn't cause bradycardia or AV block

  • Simple once-daily dosing with only three dose strengths

  • Also approved for heart failure and post-heart-attack care

Cons

  • Not used for angina or arrhythmia control

  • Can raise potassium levels, especially in heart failure

  • Contraindicated in pregnancy due to fetal harm

Diltiazem

Diltiazem's ability to both lower blood pressure and slow a fast heart rate makes it useful for people with several heart conditions at once. Because it acts directly on the heart's electrical system, it needs caution in anyone prone to a slow heart rate.

Pros

  • Also treats angina and controls heart rate in atrial fibrillation

  • Available as an IV for rapid rate control in the hospital

  • Long track record, approved by the FDA since 1982

Cons

  • Can cause bradycardia and first-degree AV block

  • Contraindicated in sick sinus syndrome and advanced AV block

  • Multiple formulations (IR, SR, ER) can create dosing mix-ups

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