From the Guidelines
Amlodipine is an appropriate medication for a 43-year-old hypertensive patient, with a typical starting dose of 5 mg once daily, which can be increased to 10 mg daily if blood pressure remains uncontrolled after 2-4 weeks. The patient should take amlodipine at the same time each day to maintain consistent blood levels, with or without food. Common side effects include peripheral edema (swelling in the ankles or feet), headache, flushing, and dizziness 1.
Key Considerations
- The patient should monitor their blood pressure regularly at home and report readings consistently above 130/80 mmHg to their healthcare provider 1.
- Amlodipine works by blocking calcium channels in blood vessel walls, causing vasodilation and reducing peripheral resistance, which effectively lowers blood pressure.
- The patient should continue other lifestyle modifications including:
- Reducing sodium intake
- Maintaining a healthy weight
- Regular exercise
- Limiting alcohol consumption
- Avoiding tobacco
- Regular follow-up appointments every 3-6 months are recommended to assess medication effectiveness and monitor for side effects.
Evidence-Based Recommendations
The European guidelines on cardiovascular disease prevention in clinical practice (version 2012) suggest that the choice of antihypertensive drugs should not be guided by age, and that thiazide diuretics, ACE inhibitors, calcium antagonists, angiotensin receptor antagonists, and beta-blockers can be considered for initiation and maintenance of treatment 1. However, the most recent and highest quality study, which is not available in the provided evidence, should be consulted for the most up-to-date recommendations.
Monitoring and Follow-Up
The patient's blood pressure should be monitored regularly, and the medication dosage should be adjusted as needed to achieve a blood pressure goal of <130/80 mmHg 1. The patient should also be monitored for potential side effects, such as peripheral edema, headache, flushing, and dizziness.
From the FDA Drug Label
The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. Amlodipine inhibits calcium ion influx across cell membranes selectively, with a greater effect on vascular smooth muscle cells than on cardiac muscle cells Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure
The patient's hypertension can be managed with amlodipine as it reduces blood pressure by acting as a peripheral arterial vasodilator.
- Key benefits of amlodipine include:
- Reduction in peripheral vascular resistance
- Decrease in blood pressure
- Effective for patients with mild to moderate hypertension
- Can be used in patients with chronic stable angina and vasospastic angina 2
From the Research
Patient Profile
- Age: 43 years old
- Condition: Hypertensive
- Medication: Amlodipine
Amlodipine Efficacy and Safety
- Amlodipine has been shown to be effective in reducing blood pressure and protecting against stroke and myocardial infarction 3, 4
- It has a low renal clearance and long half-life, allowing for sustained anti-hypertensive effects 3
- Common side effects include edema, palpitations, dizziness, and flushing, which are more common with higher doses 3
Combination Therapy
- Adding an angiotensin converting enzyme (ACE) inhibitor to amlodipine has been shown to be effective in reducing blood pressure and attenuating lower extremity edema 5
- The combination of an ACE inhibitor and amlodipine is considered a first-choice therapy for hypertension, according to the 2018 ESH/ESC guidelines 6
Age-Related Considerations
- Amlodipine has been shown to be effective and well-tolerated in elderly patients (> or =65 years of age) with mild to moderate hypertension 7
- The efficacy and tolerability of amlodipine are similar across different age groups, including those > or =75 years of age 7