From the Guidelines
Amlodipine and hydrochlorothiazide can be safely used together as a combination therapy for hypertension management, as they lower blood pressure through different mechanisms, with amlodipine relaxing blood vessel walls and hydrochlorothiazide reducing fluid volume by increasing urination. This combination is supported by the most recent guidelines, including the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The combination of a calcium channel blocker and a thiazide diuretic is a recommended treatment strategy, as it provides complementary blood pressure-lowering effects and may allow for lower doses of each medication while reducing side effects.
Key Considerations
- Typical dosing ranges from 2.5-10 mg daily for amlodipine and 12.5-25 mg daily for hydrochlorothiazide, often taken as a single daily dose.
- Monitor for side effects, including dizziness, ankle swelling, increased urination, and electrolyte imbalances (particularly potassium).
- Regular blood tests to check electrolytes and kidney function are recommended.
- Stay well-hydrated, but be aware that the increased urination from hydrochlorothiazide may be more pronounced initially.
Evidence-Based Recommendations
- The European guidelines on cardiovascular disease prevention in clinical practice (2012) support the use of combination treatment, including the combination of a diuretic with a calcium channel blocker, as it provides an extra blood pressure reduction and may offer advantages for treatment initiation 1.
- The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (2003) lists various combination drugs for hypertension, including calcium channel blockers and diuretics, but does not specifically mention the combination of amlodipine and hydrochlorothiazide 1.
- However, the most recent guideline from 2017 1 provides the strongest evidence for the use of this combination, as it is based on the latest research and clinical trials.