https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943146/
"The reports of severe syncope in
association with the use of valsartan in
the VALUE trial seemingly, therefore,
add further support to the hypothesis2
that blockade of angiotensin II type I
receptors removes the modulating
Correspondence
effects of angiotensin II on the BezoldJarisch reflex and, particularly in
circumstances when a vaso-vagal
reaction is likely to arise, there is
sensitisation of the pathway and
exaggeration of the withdrawal of
sympathetic tone, vasodilatation, and
profound bradycardia. Despite the fact
that drug-related and dose-related side effects have not been identified in
placebo-controlled trials of ARBs, postmarketing surveillance studies have
reported dizziness as one of the most
common symptoms associated with
the use of these drugs. The
identification of an uncommon side-effect of a drug depends on clinical
vigilance and doctors should be aware
of this possible adverse reaction to
ARBs, particularly in the context of their
increasing use in the management of
hypertension and heart failure. "
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(04)17013-X.pdf
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