Amlodipine Does Not Lower Heart Rate

Amlodipine does not significantly affect heart rate at therapeutic doses, despite its effectiveness in lowering blood pressure. 1

Pharmacological Effects of Amlodipine

Amlodipine is a dihydropyridine calcium channel blocker that primarily causes peripheral arterial vasodilation, acting directly on vascular smooth muscle to reduce peripheral vascular resistance and blood pressure 1
Unlike non-dihydropyridine calcium channel blockers (diltiazem and verapamil), amlodipine has minimal direct effects on cardiac contractility, atrioventricular conduction, and heart rate 2
While acute intravenous administration of amlodipine may increase heart rate in hemodynamic studies, chronic oral administration in clinical trials did not lead to clinically significant changes in heart rate in normotensive patients with angina 1

In long-term hemodynamic studies, amlodipine treatment for 11 months showed no significant changes in heart rate while effectively reducing blood pressure through reduction in total peripheral resistance 3
Morning versus evening administration studies of amlodipine demonstrated that regardless of dosing time, amlodipine had no effect on heart rate while sufficiently reducing blood pressure in hypertensive patients 4
In patients with hypertension and left ventricular hypertrophy, once-daily amlodipine (5-10 mg/day) provided consistent antihypertensive effects without affecting heart rate 5

Unlike beta-blockers, which significantly reduce heart rate, amlodipine lowers blood pressure without this effect 6
In the EXPLOR study comparing amlodipine-valsartan with amlodipine-atenolol combinations, heart rate decreased significantly more with the amlodipine-atenolol combination (difference: -11 bpm), highlighting that the heart rate reduction was due to atenolol, not amlodipine 6
The ASCOT trial showed that amlodipine-based therapy was superior to atenolol-based therapy in reducing stroke and mortality, despite different effects on heart rate 2

The lack of heart rate effects with amlodipine may be advantageous in certain patient populations where heart rate reduction is not desired 2
For patients requiring both blood pressure control and heart rate reduction, combination therapy with a beta-blocker may be appropriate 2
In patients with vasospastic angina, calcium channel blockers like amlodipine are preferred due to their coronary vasodilation properties, regardless of their neutral effect on heart rate 2

When heart rate control is a primary treatment goal (such as in certain arrhythmias or angina), non-dihydropyridine calcium channel blockers (diltiazem, verapamil) or beta-blockers would be more appropriate choices than amlodipine 2
Amlodipine can be safely combined with beta-blockers without adverse effects on electrocardiographic parameters 1
Caution should be exercised when using calcium channel blockers in patients with heart failure, though amlodipine has been shown to be relatively safe in this population compared to other calcium channel blockers 2