ACE Inhibitor and Calcium Channel Blocker Combination Medications
The most effective combination medications containing an ACE inhibitor and a calcium channel blocker include perindopril/amlodipine, lisinopril/amlodipine, benazepril/amlodipine, trandolapril/verapamil, and enalapril/felodipine. 1
Available Combination Products
- Perindopril/amlodipine - A fixed-dose combination that has shown optimal results in clinical studies, particularly beneficial for patients with uncontrolled hypertension or cardiovascular risk factors 2
- Benazepril/amlodipine - One of the most widely used combinations, available in various dosage strengths 1
- Trandolapril/verapamil - Combines an ACE inhibitor with a non-dihydropyridine calcium channel blocker 1
- Lisinopril/amlodipine - Effective combination for hypertension management 1
- Enalapril/felodipine - Another available fixed-dose combination 1
Therapeutic Rationale
- The combination of an ACE inhibitor and a calcium channel blocker provides complementary mechanisms of action, resulting in additive blood pressure lowering effects 1
- This combination is specifically recommended by major guidelines as one of the preferred combinations for hypertension management due to its effectiveness in reducing cardiovascular events 3
- Fixed-dose combinations improve medication adherence by reducing the number of pills taken by patients 3, 2
- The combination targets different blood pressure control systems, creating a synergistic effect 1, 4
Clinical Evidence Supporting This Combination
- The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines specifically recommend ACE inhibitor + calcium channel blocker as an effective two-drug combination for hypertension management 3
- This combination has been shown to reduce cardiovascular events more effectively than some other combinations, with a synergistic effect on blood pressure control 1, 5
- In patients with resistant hypertension, a triple drug regimen of an ACE inhibitor, calcium channel blocker, and a thiazide diuretic is effective and generally well tolerated 3
Important Considerations
- Dihydropyridine CCBs (like amlodipine) are most commonly combined with ACE inhibitors, while non-dihydropyridine CCBs (like verapamil, diltiazem) can also be used with ACE inhibitors, though they have different side effect profiles 1
- The combination may improve endothelial function more than either agent alone, potentially leading to better cardiovascular outcomes than a diuretic/ACE inhibitor combination 5
- This combination is particularly beneficial for patients with diabetes mellitus, metabolic syndrome, or higher cardiovascular risk 2
Contraindications and Cautions
- Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) should be avoided in patients with heart failure 3
- Blood pressure should be monitored closely after starting this combination, especially during the first month of therapy 1
- Avoid combining an ACE inhibitor with an angiotensin receptor blocker (ARB), as this combination increases cardiovascular and renal risk without additional benefit 6
Special Populations
- This combination is recommended for patients with diabetes, chronic kidney disease with albuminuria, or high cardiovascular risk 1
- The combination is appropriate for Black patients after initial therapy, and for elderly patients, but with careful monitoring and dose adjustment 1
- In hypertensive animal models, the combination of verapamil and trandolapril has been shown to normalize endothelial dysfunction 4
- The combination therapy has shown additive preventive effects on hypertensive heart failure with preserved systolic function in experimental models 7