From the Guidelines
Amlodipine should be used with caution in patients with heart failure, primarily for the treatment of hypertension in those who have elevated blood pressure despite optimization of guideline-directed medical therapy (GDMT) 1. When considering the use of amlodipine, it's crucial to understand its mechanism of action and potential benefits and limitations. Amlodipine is a second-generation dihydropyridine calcium channel blocker that has greater selectivity for calcium channels in vascular smooth muscle cells and less myocardial depressant activity compared to first-generation calcium channel blockers. Key points to consider when prescribing amlodipine include:
- Its potential role in reducing peripheral vasoconstriction and left ventricular (LV) afterload, which could be beneficial in the management of chronic heart failure (HF) 1.
- The results of the PRAISE-1 study, which showed a reduction in mortality in the subgroup of patients with nonischemic cardiomyopathy who received amlodipine, although this finding was not confirmed in the PRAISE-2 trial 1.
- The recommendation that dihydropyridine calcium channel blockers, such as amlodipine, may be used for the treatment of hypertension in patients with elevated blood pressure despite optimization of GDMT 1. It's essential to weigh these factors and consider the individual patient's condition, including the presence of heart failure, hypertension, and other comorbidities, when deciding whether to prescribe amlodipine. In clinical practice, the use of amlodipine should prioritize the management of hypertension in patients with heart failure, with careful monitoring of blood pressure and potential side effects 1.
From the FDA Drug Label
12 CLINICAL PHARMACOLOGY
- 1 Mechanism of Action Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow-channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle.
The primary mechanism of action of Amlodipine is as a dihydropyridine calcium antagonist, which inhibits the influx of calcium ions into vascular smooth muscle and cardiac muscle.
- The drug has a greater effect on vascular smooth muscle cells than on cardiac muscle cells.
- Amlodipine acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure 2.
From the Research
Amlodipine Overview
- Amlodipine is a calcium channel blocker used to treat hypertension and other cardiovascular diseases 3, 4, 5.
- It has been shown to be effective in reducing blood pressure and improving patient outcomes 3, 5.
Efficacy and Safety
- Amlodipine has been compared to other calcium channel blockers, such as nifedipine, and has been found to be similarly effective and safe 3.
- Combination therapy with amlodipine and an angiotensin-converting enzyme (ACE) inhibitor has been shown to be effective in lowering blood pressure and reducing adverse events 6.
- Amlodipine has been found to be at least as efficacious as other classes of antihypertensive agents in reducing systolic and diastolic blood pressure 7.
Specific Patient Populations
- Amlodipine has been studied in patients with concomitant diabetes mellitus and/or renal dysfunction, and has been found to be an effective and safe treatment option 7.
- In patients with diabetes, amlodipine has been shown to decrease the risk of stroke, but may increase the risk of congestive heart failure 7.
- In patients with renal dysfunction, amlodipine has been shown to decrease the risk of stroke, with no difference in other cardiovascular outcomes compared to other antihypertensive agents 7.