From the Guidelines
Amlodipine is not recommended as first-line treatment for hypertensive urgency due to its slow onset of action. Hypertensive urgency requires prompt blood pressure reduction within hours, while amlodipine takes 6-12 hours to begin working and reaches peak effect after 24-48 hours 1. For hypertensive urgency, preferred oral medications include captopril (25 mg), labetalol (200-400 mg), or clonidine (0.1-0.2 mg), which begin working within 30-60 minutes.
Key Considerations
- If using amlodipine in this setting, it should be as an adjunct to faster-acting agents, typically at a dose of 5-10 mg.
- Patients with hypertensive urgency should have their blood pressure monitored frequently during the first few hours of treatment, with a goal of reducing blood pressure by no more than 25% in the first 24 hours to avoid organ hypoperfusion 1.
- The underlying cause of the hypertensive urgency should also be investigated and addressed, as this may be due to medication non-adherence, substance use, or other secondary causes of hypertension.
Additional Context
While amlodipine may not be the first-line treatment for hypertensive urgency, it can be beneficial in certain situations, such as in patients with coronary heart disease or heart failure, where it can help reduce blood pressure and improve outcomes 2. However, in the context of hypertensive urgency, the primary goal is to rapidly reduce blood pressure and prevent target organ damage, making faster-acting agents the preferred choice.
From the FDA Drug Label
1 INDICATIONS & USAGE
- 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
12 CLINICAL PHARMACOLOGY
- 1 Mechanism of Action Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow-channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle.
The role of Amlodipine (Calcium Channel Blocker) in managing hypertensive urgency is not explicitly stated in the provided drug labels. Amlodipine is indicated for the treatment of hypertension to lower blood pressure, but the labels do not provide direct information on its use in managing hypertensive urgency specifically.
Key points:
- Amlodipine is used to treat hypertension and angina.
- It works by relaxing blood vessels, which helps lower blood pressure.
- The labels do not provide information on the use of amlodipine in hypertensive urgency.
From the Research
Role of Amlodipine in Managing Hypertensive Urgency
- Amlodipine is a calcium channel blocker that can be used to manage hypertensive urgency 4.
- Hypertensive urgency is defined as severe elevation in blood pressure without evidence of acute or progressive target-organ damage, and can be treated with oral or sublingual drugs 4.
- The goal of treatment in hypertensive urgency is to slowly control blood pressure over 24 hours, and amlodipine can be used to achieve this goal 5.
- However, according to a systematic review and meta-analysis, angiotensin-converting enzyme inhibitors may have a superior effect in treating hypertensive urgencies compared to calcium channel blockers like amlodipine 4.
- Common adverse events associated with calcium channel blockers like amlodipine include headache, flushing, and palpitations 4.
Comparison with Other Agents
- Other oral agents that can be used to manage hypertensive urgency include nifedipine, captopril, clonidine, labetalol, prazosin, and nimodipine 6, 7.
- The choice of agent depends on the patient's clinical presentation and the presence of any underlying medical conditions 8, 6.
- Intravenous antihypertensive agents like labetalol, esmolol, fenoldopam, nicardipine, and sodium nitroprusside are typically reserved for hypertensive emergencies, where there is evidence of acute end-organ damage 8, 6, 7.