What guidelines support the use of Enalapril (Angiotensin-Converting Enzyme Inhibitor) and Amlodipine (Calcium Channel Blocker) to manage Hypertension?

From the Guidelines

Enalapril and amlodipine are recommended as first-line medications for managing hypertension, either as monotherapy or in combination, due to their complementary mechanisms of action and effectiveness in reducing blood pressure and improving patient outcomes, as supported by the most recent guidelines 1.

Key Considerations for Treatment

• For initial treatment, start with enalapril 5-10 mg once daily or amlodipine 5 mg once daily, titrating up as needed to maximum doses of 40 mg for enalapril and 10 mg for amlodipine.
• In patients with stage 2 hypertension (BP ≥140/90 mmHg) or those not achieving target blood pressure with monotherapy, combination therapy is recommended, typically starting with enalapril 10 mg and amlodipine 5 mg daily.
• Enalapril is particularly beneficial for patients with heart failure, diabetes, or proteinuria, while amlodipine is effective in isolated systolic hypertension and is metabolically neutral.

Monitoring and Adjustments

• Monitor renal function and potassium levels when initiating enalapril, and watch for peripheral edema with amlodipine.
• Combination therapy often allows for lower doses of each medication, potentially reducing side effects while maintaining efficacy.
• Blood pressure should be monitored regularly, with a target of <130/80 mmHg for most adults, adjusting treatment as needed to achieve and maintain control, as recommended by recent guidelines 1.

Guideline Recommendations

• The use of fixed-dose combinations, such as enalapril and amlodipine, is recommended to improve adherence and simplify treatment regimens 1.
• Monthly visits until blood pressure target is achieved, and the use of telehealth strategies to augment office-based management, can also enhance blood pressure control 1.

From the FDA Drug Label

Enalapril maleate is indicated for the treatment of hypertension. Enalapril maleate is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. There is no information in the provided drug label about the use of amlodipine to manage blood pressure in combination with enalapril. The FDA drug label does not answer the question.

From the Research

Guideline for Managing Blood Pressure with Enalapril and Amlodipine

• The combination of enalapril and amlodipine can be effective in managing blood pressure, as shown in studies 2, 3, 4.
• Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, and amlodipine, a calcium channel blocker, have been compared in several studies, demonstrating their efficacy in reducing blood pressure 2, 5, 6.
• A study published in the Journal of Human Hypertension found that both enalapril and amlodipine were effective in lowering blood pressure, with similar results in terms of quality of life and tolerability 2.
• Another study published in the Journal of Cardiovascular Pharmacology found that adding amlodipine to enalapril therapy resulted in significant reductions in blood pressure, with no significant differences in pulse rate, ECG, or body weight 4.
• The safety and efficacy of amlodipine versus enalapril as monotherapy were evaluated in a study published in the British Journal of Clinical Pharmacology, which found that both drugs were reasonably well tolerated, with similar reductions in blood pressure 5.
• A multicentre study published in the Journal of Hypertension found that quality of life was equally well maintained on amlodipine and enalapril therapy, with similar blood pressure reductions 6.
• Common adverse events associated with enalapril include cough, while amlodipine is often associated with oedema 2, 6.
• The combination of enalapril and amlodipine may be considered for patients with moderate to severe hypertension who are not adequately controlled by monotherapy 3, 4.