Add an ACE Inhibitor or ARB to Your Amlodipine 10mg
Since your blood pressure remains uncontrolled on amlodipine 10mg alone, you should add either an ACE inhibitor (like lisinopril) or an ARB (like valsartan or olmesartan) as your second medication. 1
Why This Combination Works
The 2024 European Society of Cardiology guidelines specifically recommend combining a calcium channel blocker like amlodipine with a RAS blocker (ACE inhibitor or ARB) as the preferred two-drug combination for uncontrolled hypertension. 1 This pairing provides complementary blood pressure control through different mechanisms:
- Amlodipine relaxes blood vessels through calcium channel blockade 1
- ACE inhibitors/ARBs block the renin-angiotensin system that raises blood pressure 1
The combination of amlodipine with an ACE inhibitor has demonstrated superior blood pressure control compared to either agent alone, particularly in patients with diabetes, chronic kidney disease, or heart failure. 2
Specific Medication Options
First choice: Add an ACE inhibitor
Alternative: Add an ARB (if ACE inhibitor causes cough)
What to Expect
Research shows that only 24-28% of patients achieve blood pressure control on monotherapy—most require at least two medications. 5 The combination of amlodipine plus an ACE inhibitor or ARB typically reduces blood pressure by an additional 10-15 mmHg systolic beyond what amlodipine achieves alone. 3
Important Monitoring
After adding the second medication, you should: 2
- Recheck blood pressure within 2-4 weeks
- Monitor kidney function and potassium levels (ACE inhibitors/ARBs can affect these) 2
- Watch for side effects: dry cough with ACE inhibitors, or dizziness from excessive blood pressure lowering 2
If Two Drugs Aren't Enough
If your blood pressure remains above 140/90 mmHg despite optimized doses of amlodipine plus an ACE inhibitor/ARB, the next step is adding a thiazide-like diuretic (chlorthalidone or hydrochlorothiazide) as your third medication. 1 This three-drug combination (RAS blocker + calcium channel blocker + diuretic) represents the guideline-recommended approach for resistant hypertension. 1
Critical Pitfall to Avoid
Never combine an ACE inhibitor with an ARB—this dual RAS blockade increases adverse effects without providing additional blood pressure benefit and is explicitly not recommended. 1
Special Consideration: Reducing Ankle Swelling
If you've experienced ankle swelling from amlodipine (a common side effect), adding an ACE inhibitor or ARB may actually reduce this edema while improving blood pressure control. 2