What is the role of Amlodipine (Calcium Channel Blocker) in managing Hypertension (HTN)?

From the Guidelines

Amlodipine is a recommended first-line treatment for hypertension (HTN) due to its efficacy and safety profile, as supported by the most recent guidelines 1.

Key Points to Consider

• Amlodipine is a long-acting calcium channel blocker that provides 24-hour blood pressure control with a single daily dose.
• The typical starting dose is 5 mg once daily, which can be increased to 10 mg daily if blood pressure control is inadequate after 2-4 weeks.
• Common side effects include peripheral edema, headache, flushing, and dizziness, which are usually mild and often diminish over time.
• Amlodipine can be used alone or combined with other antihypertensive medications like ACE inhibitors, ARBs, or diuretics for enhanced blood pressure control.

Guideline Recommendations

• The 2021 guideline-driven management of hypertension recommends using long-acting amlodipine as the first-line calcium channel blocker 1.
• The guideline also emphasizes the importance of monthly visits until blood pressure target is achieved, using fixed-dose combinations, and substituting long-acting chlorthalidone for hydrochlorothiazide.

Clinical Considerations

• Amlodipine is particularly useful for elderly patients and those with coronary artery disease.
• It is essential to continue regular blood pressure monitoring while using this medication and to adjust the dose as needed to achieve optimal blood pressure control.
• The 2022 AHA/ACC/HFSA guideline for the management of heart failure also supports the use of amlodipine for treating hypertension in patients with elevated blood pressure despite optimization of guideline-directed medical therapy (GDMT) 1.

From the FDA Drug Label

1 INDICATIONS & USAGE

1. 1 Hypertension Amlodipine besylate tablets 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 Amlodipine besylate tablets.

• Amlodipine is indicated for the treatment of hypertension to lower blood pressure.
• The goal of treating hypertension with Amlodipine is to reduce the risk of fatal and nonfatal cardiovascular events, such as strokes and myocardial infarctions 2.
• Amlodipine may be used alone or in combination with other antihypertensive agents.

From the Research

Amlodipine and Hypertension

• Amlodipine is a dihydropyridine calcium channel blocker that has been widely used for the treatment of hypertension 3.
• The incremental blood pressure-lowering effect of titrating amlodipine has been assessed in patients with hypertension, including those aged ≥55 years, and has been shown to be effective in reducing blood pressure 4.
• Amlodipine has been compared to other antihypertensive agents, such as lisinopril and hydrochlorothiazide, and has been found to be well tolerated and efficacious in achieving blood pressure goals 5.

Combination Therapy

• Combination therapy with amlodipine and other antihypertensive agents, such as valsartan or ramipril, has been shown to be effective in reducing blood pressure and improving patient outcomes 5, 6.
• The combination of amlodipine and ramipril has been recommended as a first-choice therapy for hypertension, based on the 2018 ESH/ESC guidelines 6.
• Triple fixed-dose combination therapy with an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic, such as olmesartan, amlodipine, and hydrochlorothiazide, has been shown to be effective in reducing blood pressure and improving patient outcomes 7.

Efficacy and Safety

• Amlodipine has been shown to be effective in reducing blood pressure and improving patient outcomes, with a good safety profile 4, 3.
• The efficacy and safety of amlodipine have been compared to other antihypertensive agents, and have been found to be similar or superior in some cases 5, 6.
• The combination of amlodipine with other antihypertensive agents has been shown to be well tolerated and efficacious, with a low risk of adverse events 5, 6, 7.