Can amlodipine (calcium channel blocker) and atenolol (beta blocker) be given together in the long term?

From the Guidelines

Amlodipine and atenolol can be used together long-term for blood pressure and heart condition management, but this combination requires regular medical supervision, as evidenced by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. These medications work differently - amlodipine is a calcium channel blocker that relaxes blood vessels, while atenolol is a beta-blocker that reduces heart rate and cardiac output. Together, they can provide effective blood pressure control through complementary mechanisms. However, this combination may increase the risk of side effects like excessive blood pressure lowering, dizziness, fatigue, and edema, as noted in the guidelines for the primary prevention of stroke 1. Patients taking both medications should have regular check-ups to monitor blood pressure, heart rate, and potential side effects. Dose adjustments may be necessary over time, especially in elderly patients or those with kidney or liver impairment, as recommended in the 2024 ESC guidelines 1. Patients should never stop either medication abruptly as this could cause rebound hypertension or worsening of cardiac symptoms. Any concerning symptoms like severe dizziness, fainting, or significant swelling should prompt immediate medical attention. It is also important to consider the potential increased risk of type 2 diabetes associated with beta-blocker therapy, as found in a meta-analysis examining the association between β-adrenergic receptor blockers and the risk for development of type 2 diabetes mellitus 1. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) also compared the effects of amlodipine-based and atenolol-based regimens on cardiovascular events in patients with diabetes mellitus, and found that the amlodipine-based therapy reduced the incidence of total cardiovascular events and procedures compared with the atenolol-based regimen 1. Therefore, the combination of amlodipine and atenolol should be used with caution and under close medical supervision, taking into account the potential benefits and risks, as recommended in the 2024 ESC guidelines 1. Key considerations for the use of this combination include:

• Regular monitoring of blood pressure, heart rate, and potential side effects
• Dose adjustments as necessary, especially in elderly patients or those with kidney or liver impairment
• Consideration of the potential increased risk of type 2 diabetes associated with beta-blocker therapy
• Close medical supervision to minimize the risk of adverse effects and optimize treatment outcomes.

From the Research

Combination Therapy of Amlodipine and Atenolol

• The combination of amlodipine (calcium channel blocker) and atenolol (beta blocker) has been studied in various research papers to evaluate its efficacy and safety in treating hypertension 2, 3, 4, 5, 6.
• A study published in the American journal of therapeutics in 2010 found that the combination of atenolol and amlodipine was superior to atenolol monotherapy in reducing blood pressure and achieving normalization of blood pressure in patients with mild-to-moderate essential hypertension 2.
• Another study published in the American journal of hypertension in 1992 compared the efficacy and safety of amlodipine and atenolol in patients with mild-to-moderate essential hypertension and found that both treatments were well-tolerated and provided adequate blood pressure control throughout the 24-h dosing interval 3.
• Research on spontaneously hypertensive rats has also shown that the combination of atenolol and amlodipine has a synergistic effect in lowering and stabilizing blood pressure, with the best dose proportion being 10:1 4.
• A study published in the American heart journal in 1999 evaluated the short-term and long-term hemodynamic and clinical effects of metoprolol alone and combined with amlodipine in patients with chronic heart failure and found that combination therapy was well-tolerated and produced significant long-term decreases in blood pressure 5.
• Additionally, a study published in the Journal of cellular and molecular medicine in 2009 found that the combination of atenolol and amlodipine was better than their monotherapy for preventing end-organ damage in different types of hypertension in rats 6.

Long-Term Use

• The long-term use of the combination of amlodipine and atenolol has been evaluated in several studies, including the one published in the American journal of therapeutics in 2010, which found that the combination was safe and effective in reducing blood pressure over a 12-week period 2.
• Another study published in the American heart journal in 1999 found that long-term therapy with the combination of metoprolol and amlodipine produced significant decreases in blood pressure and improvements in hemodynamic parameters in patients with chronic heart failure 5.

Safety and Efficacy

• The safety and efficacy of the combination of amlodipine and atenolol have been evaluated in several studies, including the ones published in the American journal of hypertension in 1992 and the American heart journal in 1999, which found that the combination was well-tolerated and provided adequate blood pressure control 3, 5.
• The study published in the Journal of cellular and molecular medicine in 2009 also found that the combination of atenolol and amlodipine had a synergistic inhibitory effect on blood pressure and blood pressure variability, and end-organ damage as compared with monotherapy with atenolol or amlodipine in all animal models 6.