From the Guidelines
A good medication to add to amlodipine 10 mg daily for a patient with persistently elevated blood pressure would be a diuretic, specifically spironolactone 25-50 mg daily, as it is recommended as a fourth-line agent in the 2020 international society of hypertension global hypertension practice guidelines 1. This recommendation is based on the most recent guidelines, which suggest optimizing the current treatment regimen and adding a low dose of spironolactone to achieve blood pressure targets. The use of spironolactone is supported by its efficacy in reducing blood pressure and its potential benefits in patients with resistant hypertension. Some key points to consider when adding spironolactone to amlodipine include:
- Monitoring serum potassium levels, as spironolactone can increase the risk of hyperkalemia 1
- Ensuring the patient's eGFR is >45 ml/min/1.73m2, as spironolactone is not recommended in patients with significant renal dysfunction 1
- Starting with a low dose and titrating as needed to minimize the risk of adverse effects
- Considering alternative agents, such as amiloride, doxazosin, eplerenone, clonidine, or beta-blockers, if spironolactone is contraindicated or not tolerated 1 It is essential to individualize treatment and consider the patient's specific clinical profile, including comorbidities and potential drug interactions, when selecting an additional medication to amlodipine.
From the Research
Potential Medication Options to Add to Amlodipine
- Considering the patient is already taking amlodipine 10 mg daily for hypertension, the following medications could be potential additions to help lower blood pressure:
- Angiotensin-converting enzyme (ACE) inhibitors, such as quinapril or perindopril, as they have been shown to produce additional antihypertensive effects when used in combination with amlodipine 2, 3, 4
- Angiotensin receptor blockers (ARBs), such as losartan, as they have been found to be equally effective as ACE inhibitors in reducing blood pressure and improving arterial stiffness 3, 5, 6
- Thiazide diuretics, such as hydrochlorothiazide, as they can be used in combination with amlodipine to produce important additional antihypertensive effects 2, 5
- Sodium-glucose cotransporter-2 inhibitors, such as canagliflozin, as they have been shown to reduce blood pressure and improve arterial stiffness in patients with type 2 diabetes and hypertension 4
Considerations for Medication Selection
- When selecting a medication to add to amlodipine, it is essential to consider the patient's individual characteristics, such as the presence of diabetes or kidney disease, as well as potential side effects and interactions with other medications 3, 6, 4
- The choice of medication should be based on the patient's specific needs and medical history, as well as the potential benefits and risks of each medication option 2, 5, 6