Lisinopril and Amlodipine Combination Therapy for Hypertension
Yes, lisinopril (ACE inhibitor) and amlodipine (calcium channel blocker) can be safely and effectively taken together at the same time. In fact, this combination is specifically recommended in hypertension management guidelines due to its complementary mechanisms of action and proven efficacy.
Benefits of Combining Lisinopril and Amlodipine
- The combination of an ACE inhibitor (like lisinopril) and a calcium channel blocker (like amlodipine) provides complementary mechanisms of action, resulting in more effective blood pressure reduction than either medication alone 1
- This combination targets different blood pressure control mechanisms: ACE inhibitors block the renin-angiotensin system while calcium channel blockers affect calcium-dependent vascular smooth muscle contraction 1
- When combined, these medications can allow for lower doses of each individual drug, potentially reducing side effects while maintaining efficacy 1
- Studies have shown a significant additional blood pressure lowering effect with the combination compared to either agent alone 2, 3
Evidence Supporting This Combination
- The European Society of Cardiology recommends the combination of an ACE inhibitor and a dihydropyridine calcium channel blocker as one of the preferred combinations for treating hypertension 1
- Clinical trials have demonstrated that the combination of lisinopril and amlodipine produces a much more significant lowering of blood pressure in a higher percentage of patients than individual low doses of either drug 2
- The combination has shown high levels of efficacy and safety in patients with hypertension who are at different risk levels for cardiovascular complications 4
- Fixed-dose single-pill combinations containing these medication classes are available and recommended to improve adherence 1
Clinical Considerations
- The JNC 7 guidelines specifically list amlodipine-lisinopril as an available fixed-dose combination for hypertension management 5
- In the ALLHAT study, which involved more than 40,000 hypertensive individuals, both lisinopril and amlodipine were effective in lowering blood pressure 5
- For patients with chronic kidney disease, the combination may provide additional benefits, as ACE inhibitors are recommended for patients with albuminuria or renal dysfunction 5, 6
- Most patients with hypertension, especially black patients, require 2 or more antihypertensive medications to achieve adequate BP control 5
Important Cautions
- Avoid combining two RAS blockers (such as an ACE inhibitor with an ARB), as this is not recommended and can increase adverse effects 1
- Regular monitoring of serum creatinine/eGFR and potassium levels is recommended, especially for patients on ACE inhibitors 6
- Black patients may have a higher risk of angioedema with ACE inhibitors, and Asian Americans have a higher incidence of ACE inhibitor-induced cough 5
- In patients with uncontrolled hypertension, starting with the combination may be more effective than sequential monotherapy 1
The combination of lisinopril and amlodipine represents an effective strategy for blood pressure control with complementary mechanisms of action and established safety profiles when used together.