Ask The Doctor: Blood Pressure Medication and Creatinine

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Question:

Can Diovan cause an increase in creatinine levels?

Answer:

Yes, Diovan can increase creatinine levels in the blood. But this may actually be a good thing, even though we usually consider higher creatinine levels a sign of worse kidney function.

First, we need to review a few basics about Diovan and other drugs in the same class.

Diovan is used to treat high blood pressure and congestive heart failure. It is also used to help prevent progressive kidney damage in people who test positive for protein in the urine (called proteinuria or albuminuria). This is common in people with long-standing diabetes.

Diovan is the trade name for the drug valsartan. Valsartan and similar drugs such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar) and telmisartan (Micardis) are called angiotensin II receptor blockers.

Angiotensin causes blood vessels to constrict. By blocking angiotensin, blood vessels can relax and allow blood to flow under less pressure. This means the heart and kidneys can function with less stress.

When there is a little less pressure within the kidney, there is less risk of ongoing kidney damage. However, the decreased pressure also means that blood flow through the kidney decreases. Less creatinine goes through the kidney and therefore lower amounts of creatinine pass into the urine. So, the creatinine level in the blood may rise even though the angiotensin II receptor blocker is good for the kidneys.

This is true as long as the blood flow to and through the kidney does not get too low. So it's a balance. You want to lower blood pressure but not let it get too low.

What I have described for Diovan and angiotensin II receptor blockers is also true for another class of drugs called ACE (angiotensin converting enzyme) inhibitors. They also lower angiotensin levels and are used to treat the same conditions.