From the Guidelines
The appropriate starting dose for amlodipine is typically 5 mg once daily, while ramipril usually starts at 1.25-2.5 mg once daily for hypertension treatment, as indicated by the most recent guidelines 1. When initiating therapy with these medications, it's essential to consider the patient's overall health status, including any potential kidney or liver impairment, as well as their age and other medications they may be taking.
- Amlodipine can be titrated upward to 10 mg daily if blood pressure control is not achieved, while ramipril can be increased to 5-10 mg daily (or divided into twice-daily dosing) 1.
- Patients should be monitored regularly for side effects, including ankle swelling with amlodipine and dry cough with ramipril.
- Blood pressure should be checked regularly, and kidney function and electrolytes should be monitored when using ramipril, especially in patients with existing kidney disease or those taking diuretics. The combination of amlodipine and ramipril can be effective in managing hypertension, as they work through different mechanisms to lower blood pressure, with amlodipine relaxing blood vessels as a calcium channel blocker and ramipril preventing the formation of angiotensin II as an ACE inhibitor 1.
From the Research
Amlodipine Starting Dose
- The appropriate starting dose of amlodipine for hypertension treatment is 5 mg once daily, as shown in studies 2, 3, 4.
- A dose of 2.5 mg may also be effective, but 5 mg is the most commonly recommended starting dose 3.
- The dose can be increased to 10 mg once daily if the blood pressure response is unsatisfactory after 2-4 weeks of treatment 2, 4.
Ramipril Starting Dose
- There is no direct information on the starting dose of ramipril in the provided studies.
- However, it is common practice to start with a low dose of ramipril, such as 1.25-2.5 mg once daily, and titrate up as needed to achieve the desired blood pressure response.
Combination Therapy
- The combination of amlodipine and benazepril (an ACE inhibitor similar to ramipril) has been shown to be effective in reducing blood pressure in patients who do not respond to monotherapy 5.
- The starting dose of amlodipine in combination with benazepril is 5 mg once daily, with the option to increase to 10 mg once daily if needed 5.
Note: There are no direct studies on ramipril in the provided evidence, but the information on benazepril can be used as a reference since both are ACE inhibitors.