Valsartan vs. Ramipril

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

Key Takeaways

  • Valsartan is an ARB and ramipril is an ACE inhibitor, so they lower blood pressure through related but distinct pathways, and only ramipril is linked to a persistent dry cough.

  • Valsartan has a broader heart failure indication and pediatric approval, while ramipril has a distinct approval for reducing cardiovascular risk in high-risk adults 55 and older.

  • Both are taken once daily by mouth, though ramipril's dosing schedule involves more titration steps before reaching its maximum dose.

Valsartan vs. Ramipril Drug Summary

Valsartan

Valsartan is an angiotensin receptor blocker (ARB) used to treat high blood pressure in adults and children 6 and older. It is also approved for heart failure and for reducing cardiovascular death after a heart attack in patients with left ventricular dysfunction. It comes as a once-daily tablet, with doses ranging from 80 mg up to 320 mg.

Ramipril

Ramipril is an ACE inhibitor used to treat high blood pressure in adults. It is also approved for heart failure after a heart attack and for reducing the risk of heart attack, stroke, or cardiovascular death in adults 55 and older at high risk. It comes as a once-daily capsule, with doses ranging from 2.5 mg up to 20 mg.

Valsartan vs. Ramipril Side Effects

Valsartan

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

Ramipril

Most common
Headache (up to 5.4%)
Dizziness (up to 2.2%)
Fatigue (up to 2.0%)
Cough (up to 7%)

Valsartan vs. Ramipril 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

Ramipril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose Up to 20 mg once daily If needed
Dose changes 3 increases As tolerated

Valsartan vs. Ramipril Indications

Valsartan

Valsartan is FDA-approved to lower blood pressure in adults and children 6 and older. It is also approved for heart failure (NYHA class II-IV) to reduce hospitalizations, and for use after a heart attack in patients with left ventricular dysfunction.

  • Hypertension in adults and children 6+

  • Heart failure, NYHA class II-IV

  • Post-heart attack with left ventricular dysfunction

  • Can be combined with other BP medications

Ramipril

Ramipril is FDA-approved to lower blood pressure in adults. It is also approved for stable heart failure following a heart attack, and to reduce the risk of heart attack, stroke, or cardiovascular death in adults 55 and older at high cardiovascular risk.

  • Hypertension in adults

  • Heart failure after a heart attack

  • Cardiovascular risk reduction in high-risk adults 55+

  • Can be combined with thiazide diuretics

Valsartan vs. Ramipril Pros and Cons

Valsartan

Valsartan is an ARB, so it doesn't cause the dry cough that sometimes limits ACE inhibitor use. It carries FDA approval for both pediatric hypertension and a broader heart failure indication than ramipril's post-MI-only label.

Pros

  • Doesn't cause the dry cough seen with ACE inhibitors

  • Approved for hypertension in children as young as 6

  • Approved for heart failure (NYHA II-IV), not just post-MI

  • Simple two-step titration to max dose

Cons

  • Not approved to reduce cardiovascular risk in high-risk adults without heart failure or a prior heart attack

  • Can raise potassium levels, especially in heart failure patients

  • Not indicated for routine post-heart attack use without left ventricular dysfunction

  • Requires monitoring of kidney function in heart failure patients

Ramipril

Ramipril is an ACE inhibitor with decades of outcomes data, including a distinct approval for lowering cardiovascular risk in high-risk adults over 55. Its main tradeoff is a dry, persistent cough that affects some users and isn't shared by ARBs like valsartan.

Pros

  • Approved to reduce heart attack, stroke, and death risk in high-risk adults 55+

  • Decades of outcomes data from large cardiovascular trials

  • Can be combined with thiazide diuretics for added BP control

  • Widely available as a low-cost generic

Cons

  • Causes a persistent dry cough in up to 7% of patients

  • Heart failure approval is limited to the post-heart attack setting

  • Requires more titration steps to reach the maximum dose

  • Not approved for use in children

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