From the Guidelines
For a patient with an allergy to amlodipine, the most suitable alternative antihypertensive agents are ACE inhibitors, such as lisinopril (10-40 mg daily) or enalapril (5-40 mg daily in divided doses), due to their efficacy and safety profile as stated in the 2017 ACC/AHA guideline 1.
Alternative Antihypertensive Agents
The following classes of medications can be considered as alternatives:
- Angiotensin II receptor blockers (ARBs) like losartan (50-100 mg daily) or valsartan (80-320 mg daily) which offer similar efficacy with potentially fewer side effects than ACE inhibitors 1.
- Thiazide diuretics such as hydrochlorothiazide (25-50 mg daily) or chlorthalidone (12.5-25 mg daily) which are effective and inexpensive options 1.
- Other classes of antihypertensive agents, including beta-blockers, can be considered based on the patient's specific comorbidities and clinical profile.
Considerations for Choosing Alternative Agents
When selecting an alternative antihypertensive agent, it is crucial to consider the patient's:
- Comorbidities, such as heart failure, coronary artery disease, or chronic kidney disease
- Age and race, as these factors can influence drug efficacy and tolerability
- Potential for side effects, such as cough with ACE inhibitors, electrolyte disturbances with diuretics, or bradycardia with beta-blockers
Monitoring and Follow-Up
Regular monitoring of blood pressure, kidney function, and electrolyte levels is essential when initiating or adjusting antihypertensive therapy, especially in patients with pre-existing kidney disease or those taking medications that may affect kidney function, as noted in the guideline 1.
From the Research
Alternative Antihypertensive Agents
For a patient with an allergy to amlodipine, a calcium channel blocker, there are several alternative antihypertensive agents that can be considered. These include:
- β-blockers
- Diuretics
- ACE inhibitors
- Angiotensin receptor blockers
- Other calcium channel blockers, such as verapamil 2
Specific Alternative Agents
Some specific alternative agents that have been studied include:
- Lisinopril, an ACE inhibitor
- Losartan, an angiotensin receptor blocker
- Valsartan, an angiotensin receptor blocker
- Hydrochlorothiazide, a diuretic
- These agents can be used alone or in combination with other medications to achieve optimal blood pressure control 3
Considerations for Selecting Alternative Agents
When selecting an alternative antihypertensive agent, several factors should be considered, including:
- The patient's individual needs and medical history
- The potential for adverse events
- The need for monitoring and follow-up
- The cost of the medication
- The expected duration of therapy 4
Efficacy of Alternative Agents
Studies have shown that alternative antihypertensive agents can be effective in reducing blood pressure and improving patient outcomes. For example, a study comparing amlodipine and verapamil found that both medications were effective in reducing blood pressure, but amlodipine had a more sustained effect 2. Another study found that combinations of lisinopril, losartan, and valsartan with or without hydrochlorothiazide were effective in reducing blood pressure and improving arterial stiffness 3.