From the Guidelines
Norvasc (amlodipine) 10mg and losartan can be given to a patient with CKD stage 3 and hypertension, as they are commonly used in this patient population to effectively lower blood pressure while offering renoprotective benefits. According to the 2017 ACC/AHA guideline 1, losartan, an angiotensin receptor blocker (ARB), is recommended for patients with hypertension, and amlodipine, a calcium channel blocker, is also a suitable option. The KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease 1 suggests that ARBs, such as losartan, can help reduce proteinuria and slow CKD progression.
- Key considerations for this combination therapy include:
- Monitoring for hyperkalemia and acute kidney injury, especially when starting therapy
- Regular monitoring of kidney function, potassium levels, and blood pressure
- Dosage adjustments may be necessary based on the patient's specific glomerular filtration rate (GFR)
- The patient should be educated on the potential side effects of the medications, such as dizziness, hypotension, or worsening kidney function, and the importance of reporting these to their healthcare provider. The combination of Norvasc (amlodipine) 10mg and losartan can provide synergistic blood pressure control while protecting kidney function, as supported by the network meta-analysis by Xie et al. 1, which examined the benefits of treating with RASi compared to other active therapies or placebo for kidney and cardiovascular outcomes.
From the Research
Medication Considerations for CKD Stage 3 and Hypertension
- Norvasc (amlodipine) is a dihydropyridine calcium channel blocker, and losartan is an angiotensin II receptor blocker (ARB) 2.
- According to recent guidelines, ARBs like losartan should be used if an angiotensin-converting enzyme (ACE) inhibitor is not tolerated 3, 4.
- Non-dihydropyridine CCBs are recommended for reducing albuminuria and slowing the decline in kidney function, but dihydropyridine CCBs like Norvasc should not be used as monotherapy in proteinuric CKD patients, instead used in combination with a RAAS blocker 3.
- The combination of Norvasc (10mg) and losartan may be considered for a patient with CKD stage 3 and hypertension, as losartan has been shown to decrease albumin excretion in hypertensive patients with non-diabetic nephropathy 2.
Blood Pressure Goals for CKD Stage 3
- The recommended blood pressure goal for patients with CKD stage 3 is less than 130/80 mmHg 3, 5.
- A target systolic BP of 120 to 130 mm Hg and diastolic BP of 70 to 80 mm Hg may yield the greatest benefit while avoiding most of the adverse cardiovascular outcomes associated with lower levels of BP 5.