From the Guidelines
Amlodipine has a minimal effect on heart rate in most patients. As a dihydropyridine calcium channel blocker, amlodipine primarily causes vasodilation of peripheral blood vessels with little direct impact on cardiac conduction or contractility 1. While some patients might experience a slight reflex tachycardia (increased heart rate) when first starting the medication due to the sudden drop in blood pressure, this effect is usually mild and transient compared to other vasodilators.
Key Points
- Amlodipine has a gradual onset of action and produces less sympathetic nervous system activation than other antihypertensives.
- In clinical practice, amlodipine is often preferred for patients where heart rate control is important, such as those with angina or certain arrhythmias.
- The standard dosing of amlodipine (5-10 mg daily) rarely causes significant heart rate changes, which distinguishes it from non-dihydropyridine calcium channel blockers like verapamil and diltiazem that do significantly slow heart rate 1.
Considerations
- If a patient notices persistent changes in heart rate after starting amlodipine, they should consult their healthcare provider as this may indicate an unusual response or another underlying condition.
- Studies have shown that amlodipine does not significantly affect heart rate, with one study noting "no significant change in heart rate" 1.
Clinical Implications
- Amlodipine can be used for treatment of hypertension in patients who have elevated blood pressure despite optimization of guideline-directed medical therapy (GDMT) 1.
From the FDA Drug Label
These decreases in blood pressure are not accompanied by a significant change in heart rate or plasma catecholamine levels with chronic dosing Although the acute intravenous administration of amlodipine decreases arterial blood pressure and increases heart rate in hemodynamic studies of patients with chronic stable angina, chronic oral administration of amlodipine in clinical trials did not lead to clinically significant changes in heart rate or blood pressures in normotensive patients with angina
Amlodipine does not significantly affect Heart Rate (HR) in most cases, according to the provided drug label 2. However, it is noted that acute intravenous administration can increase heart rate, but this effect is not seen with chronic oral administration.
From the Research
Amlodipine's Effect on Heart Rate
- Amlodipine is a calcium channel blocker that has been studied for its effects on blood pressure and heart rate 3, 4, 5, 6, 7.
- According to a study published in 1999, amlodipine 5 mg OD did not change heart rate in patients with mild to moderate hypertension 4.
- Another study from 2017 found that amlodipine administered in the evening reduced systolic blood pressure and heart rate in hypertensive patients, suggesting a potential chronopharmacological effect 5.
- A 2005 study compared the effects of amlodipine and lacidipine on heart rate variability in patients with stable angina pectoris and isolated left ventricular diastolic dysfunction, and found that amlodipine did not significantly change heart rate variability parameters 6.
- Overall, the evidence suggests that amlodipine may have a minimal effect on heart rate, although its impact may vary depending on the timing of administration and individual patient characteristics 3, 4, 5, 6, 7.
Key Findings
- Amlodipine is a well-tolerated and effective antihypertensive agent that can be used alone or in combination with other medications 3.
- The drug has been shown to reduce blood pressure and cardiovascular risk without significantly affecting heart rate in most studies 4, 5, 6.
- However, the timing of amlodipine administration may influence its effects on heart rate and blood pressure, with evening dosing potentially offering a more efficacious means of controlling blood pressure 5.