From the FDA Drug Label
Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions Amlodipine besylate tablets is indicated for the symptomatic treatment of chronic stable angina. Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents.
The best intervention for hypertension in a patient with coronary artery disease (CAD) and asthma is to use Amlodipine as it is indicated for both hypertension and CAD.
- Amlodipine can be used alone or in combination with other antihypertensive agents.
- There is no direct information in the provided drug labels about the treatment of asthma, but Amlodipine can be used for hypertension and CAD.
- The use of Losartan may also be considered for hypertension, but there is no direct information in the provided drug labels about its use in patients with CAD and asthma. 1
From the Research
For a patient with hypertension who also has coronary artery disease (CAD) and asthma, the best intervention would be a calcium channel blocker (CCB) such as amlodipine, starting at 5 mg daily and titrating up to 10 mg if needed. This recommendation is based on the most recent and highest quality evidence available, which suggests that CCBs are effective in managing hypertension and CAD, while also being safe for patients with asthma 2.
Key Considerations
- Beta-blockers, which are typically beneficial for CAD, should be avoided or used with extreme caution in this patient due to the risk of bronchospasm in asthma.
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) could be considered as add-on therapy if blood pressure control is inadequate with CCBs alone, as they provide cardiovascular protection for CAD patients, although a recent study suggests that ARBs may be preferred over ACE inhibitors due to their similar efficacy but lower risk of adverse events 3.
- Long-acting dihydropyridine CCBs like amlodipine are preferred because they don't worsen asthma symptoms, have minimal negative effects on cardiac function, and provide antianginal benefits for CAD.
Lifestyle Modifications
- Sodium restriction to less than 2.3g daily
- Regular physical activity appropriate to the patient's capabilities
- Weight management
- Limiting alcohol consumption
- Smoking cessation if applicable
Monitoring
- Blood pressure should be monitored regularly with a target of less than 130/80 mmHg for patients with CAD. The ALLHAT study, although older, provides valuable insights into the comparative effectiveness of different antihypertensive therapies, including CCBs, in patients with CAD 4. However, the most recent and highest quality evidence supports the use of CCBs as a first-line treatment option for patients with hypertension and CAD, particularly in those with asthma.