What is the benefit of combining lisinopril (angiotensin-converting enzyme inhibitor) 25mg and amlodipine (calcium channel blocker) 5mg for uncontrolled hypertension?

From the Guidelines

Combining lisinopril 25mg and amlodipine 5mg for uncontrolled hypertension is a highly effective approach, as it allows for the targeting of different pathways in blood pressure regulation, often achieving better control than either medication alone, as supported by the most recent guidelines 1. This combination therapy is particularly beneficial for patients whose blood pressure remains elevated on monotherapy. Lisinopril, an ACE inhibitor, works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing vasoconstriction and sodium retention. Amlodipine, a calcium channel blocker, relaxes blood vessel walls by preventing calcium from entering smooth muscle cells. When used together, these medications can provide a greater reduction in blood pressure than increasing the dose of one drug, with the potential for fewer side effects and improved adherence, as noted in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. Some key points to consider when using this combination include:

• The importance of regular blood pressure monitoring and kidney function tests
• The need for patients to stay hydrated and avoid excessive potassium intake
• The potential for common side effects such as dry cough (from lisinopril) and peripheral edema (from amlodipine)
• The benefits of this combination for patients with certain comorbidities like diabetes or heart failure, where ACE inhibitors offer additional protective effects, as highlighted in previous guidelines 1. Overall, the combination of lisinopril and amlodipine is a well-established and effective treatment strategy for uncontrolled hypertension, with a strong evidence base supporting its use, particularly in the context of the most recent clinical guidelines 1.

From the Research

Benefits of Combining Lisinopril and Amlodipine for Uncontrolled Hypertension

• The combination of lisinopril (an angiotensin-converting enzyme inhibitor) and amlodipine (a calcium channel blocker) has been shown to have a synergistic effect in patients with more severe hypertension 2, 3.
• Studies have demonstrated that the combination of lisinopril and amlodipine can provide a significant additional blood pressure-lowering effect compared to either drug alone 2, 4.
• The combination of lisinopril and amlodipine has been found to be effective in achieving blood pressure control in patients with stage 2 hypertension 5.
• The use of lisinopril and amlodipine in combination has been shown to be well-tolerated and effective in reducing blood pressure in patients with hypertension, including those with comorbidities such as arteriosclerosis obliterans 6.

Mechanism of Action and Efficacy

• The combination of lisinopril and amlodipine works by targeting different mechanisms of blood pressure regulation, with lisinopril inhibiting the conversion of angiotensin I to angiotensin II and amlodipine blocking calcium channels in vascular smooth muscle 2.
• Studies have found that the combination of lisinopril and amlodipine can provide a more significant reduction in blood pressure compared to monotherapy with either drug alone 2, 4.
• The efficacy of the combination of lisinopril and amlodipine has been demonstrated in various patient populations, including those with essential hypertension and those with comorbidities such as arteriosclerosis obliterans 6, 4.

Dosage and Titration

• The optimal dosage of lisinopril and amlodipine in combination for the treatment of uncontrolled hypertension may vary depending on the individual patient's response and tolerability 6, 5.
• Studies have used a range of dosages, including lisinopril 10-20 mg and amlodipine 5-10 mg, with titration to achieve optimal blood pressure control 6, 5.
• The combination of lisinopril and amlodipine has been found to be effective and well-tolerated at various dosages, including lower doses such as lisinopril 5 mg and amlodipine 2.5 mg 4.