Amlodipine for Hypertension in Patients with eGFR of 51
Amlodipine is recommended for treatment of hypertension in patients with an eGFR of 51 mL/min/1.73m², with an initial dose of 5 mg once daily. 1, 2
Efficacy and Safety in Renal Impairment
- Amlodipine is a dihydropyridine calcium channel blocker that can be safely used in patients with reduced renal function, as it does not require dose adjustment for moderate renal impairment (eGFR of 51) 1
- Unlike many antihypertensives, amlodipine has low renal clearance (7 mL/min/mg) and is primarily metabolized by the liver, making it suitable for patients with kidney disease 3
- Amlodipine is one of the few calcium channel blockers specifically mentioned as safe for use in heart failure patients, unlike non-dihydropyridine calcium channel blockers (diltiazem, verapamil) which should be avoided 2
- The 2024 ESC guidelines for hypertension management recommend dihydropyridine CCBs (like amlodipine) as one of the first-line treatments for hypertension 2
Dosing Recommendations
- The FDA-approved initial dose for amlodipine in hypertension is 5 mg once daily 1
- For elderly, fragile patients, or those with hepatic insufficiency, a starting dose of 2.5 mg once daily may be considered 1
- The maximum dose is 10 mg once daily, with dose titration typically occurring after 7-14 days based on blood pressure response 1, 3
- Amlodipine's long half-life (35-50 hours) allows for consistent 24-hour blood pressure control with once-daily dosing 3
Advantages in Patients with Renal Impairment
- Amlodipine controls blood pressure in patients with chronic kidney disease without worsening kidney function 3
- Research has shown that amlodipine does not adversely affect glomerular filtration rate in patients with nondiabetic nephropathies 4
- When used in combination therapy, amlodipine can be effectively paired with RAS blockers (ACE inhibitors or ARBs) for enhanced blood pressure control in patients with kidney disease 2, 5
Special Considerations
- For patients with hypertension and eGFR <60 mL/min/1.73m², a comprehensive approach often includes a RAS blocker (ACE inhibitor or ARB) along with a calcium channel blocker like amlodipine 2
- In patients with heart failure, amlodipine is specifically noted as safe, unlike other calcium channel blockers which are contraindicated 2
- Amlodipine is particularly beneficial in elderly patients (≥65 years) with hypertension, showing significant blood pressure reductions (25/16 mmHg) with good tolerability 6
Monitoring and Follow-up
- After initiating amlodipine, blood pressure should be monitored within 7-14 days to assess response and need for dose adjustment 1
- Common side effects to monitor include peripheral edema, flushing, and headache, which are more common with the 10 mg dose 3
- For patients with eGFR of 51, regular monitoring of kidney function is recommended, though amlodipine itself does not typically cause further deterioration of renal function 4
Amlodipine represents an excellent choice for treating hypertension in patients with moderate renal impairment due to its hepatic metabolism, proven efficacy, and favorable safety profile in this population.