Amlodipine vs Ramipril for hypertension?

From the Guidelines

Ramipril is preferred over amlodipine for patients with hypertension, particularly those with diabetes, heart failure, or kidney disease, due to its additional benefits in reducing proteinuria and providing cardiovascular protection beyond blood pressure control 1. When considering the treatment of hypertension, it's essential to weigh the benefits and drawbacks of different medications. Amlodipine, a calcium channel blocker, is effective in relaxing blood vessels and is often used in older patients or those with isolated systolic hypertension. However, ramipril, an ACE inhibitor, offers additional benefits for patients with specific comorbidities. Some key points to consider:

• Ramipril has been shown to reduce the risk of myocardial infarction, stroke, and cardiovascular death in patients with diabetes or vascular disease 1.
• The HOPE study demonstrated that ramipril reduced the incidence of cardiovascular events in patients with diabetes or vascular disease, regardless of blood pressure levels 1.
• The choice between amlodipine and ramipril depends on individual patient factors, including age, comorbidities, and tolerance.
• Many patients require combination therapy for optimal blood pressure control, and these medications can be used together when needed.
• Blood pressure should be monitored regularly after starting either medication, with dose adjustments made accordingly. It's also important to note that the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline recommends considering ACE inhibitors or ARBs as first-line treatment for hypertension in patients with diabetes or kidney disease 1. Overall, while both amlodipine and ramipril are effective medications for treating hypertension, ramipril is generally preferred for patients with specific comorbidities due to its additional benefits in reducing proteinuria and providing cardiovascular protection.

From the FDA Drug Label

1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.

CLINICAL STUDIES SECTION 14. 1 Hypertension Ramipril has been compared with other ACE inhibitors, beta-blockers, and thiazide diuretics as monotherapy for hypertension. It was approximately as effective as other ACE inhibitors and as atenolol

Comparison of Amlodipine and Ramipril for Hypertension:

• Both Amlodipine and Ramipril are indicated for the treatment of hypertension.
• Amlodipine is used to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events.
• Ramipril has been shown to be approximately as effective as other ACE inhibitors and atenolol in reducing blood pressure.
• The choice between Amlodipine and Ramipril may depend on individual patient factors, such as comorbidities and potential side effects 2, 3.
• Amlodipine 10mg and Ramipril 5mg are common doses used to treat hypertension, but the most effective dose and treatment regimen may vary depending on the patient's response to treatment.

From the Research

Comparison of Amlodipine and Ramipril

• Amlodipine 10mg and ramipril 5mg are both used to treat hypertension, but they belong to different classes of medications [ 4 ].
• Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, while amlodipine is a calcium channel blocker [ 5 ].
• Studies have shown that ramipril is effective in reducing blood pressure and improving outcomes in patients with hypertension and heart failure [ 5, 6, 7 ].
• Amlodipine has also been shown to be effective in reducing blood pressure and improving outcomes in patients with hypertension [ 4 ].
• A fixed-dose combination of ramipril and amlodipine has been shown to be effective in achieving target blood pressure levels in hypertensive patients, including those with diabetes [ 4 ].

Efficacy and Safety

• Ramipril has been shown to be well-tolerated and effective in reducing blood pressure in patients with mild to moderate hypertension [ 5, 7, 8 ].
• Amlodipine has also been shown to be well-tolerated and effective in reducing blood pressure in patients with hypertension [ 4 ].
• The combination of ramipril and amlodipine has been shown to be well-tolerated and effective in achieving target blood pressure levels in hypertensive patients [ 4 ].

Specific Patient Populations

• Ramipril has been shown to be effective in reducing blood pressure and improving outcomes in patients with diabetes and kidney disease [ 6 ].
• Amlodipine has also been shown to be effective in reducing blood pressure in patients with diabetes [ 4 ].
• The combination of ramipril and amlodipine has been shown to be effective in achieving target blood pressure levels in hypertensive patients with diabetes [ 4 ].