Does Amlodipine (Norvasc) Slow Down Heart Rate?
No, amlodipine does not slow down heart rate—it has minimal direct effects on heart rate, unlike non-dihydropyridine calcium channel blockers such as diltiazem or verapamil. 1, 2
Mechanism and Pharmacological Properties
Amlodipine is a dihydropyridine calcium channel blocker that works primarily through peripheral arterial vasodilation. The FDA label explicitly states that amlodipine has minimal effects on cardiac contractility, atrioventricular conduction, and heart rate. 2 This distinguishes it fundamentally from non-dihydropyridine calcium channel blockers (verapamil and diltiazem), which have significant negative chronotropic effects and directly slow heart rate. 3
The drug selectively inhibits calcium influx into vascular smooth muscle cells more than cardiac muscle cells, resulting in blood pressure reduction without significant heart rate changes. 2
Clinical Evidence
Multiple clinical trials and guidelines confirm amlodipine's neutral effect on heart rate:
In hypertensive patients, chronic oral administration of amlodipine does not lead to clinically significant changes in heart rate. 2 The FDA label notes that blood pressure reductions occur "without a significant change in heart rate or plasma catecholamine levels with chronic dosing." 2
Research studies consistently show heart rate remains unchanged with amlodipine treatment. In a study of 20 hypertensive patients, heart rate remained stable at 78-77 beats per minute despite significant blood pressure reductions. 4 Another ambulatory blood pressure monitoring study found "amlodipine treatment had no effect on heart rate." 5
In post-myocardial infarction patients treated with amlodipine for 2 years, heart rate remained unchanged despite improvements in other cardiac parameters. 6
When combined with beta-blockers (which do slow heart rate), amlodipine does not interfere with cardiac rhythm or function. A study of patients on atenolol who added amlodipine showed no change in 24-hour heart rate measurements, heart rate variation, or cardiac output. 7
Clinical Implications
If heart rate control is a primary treatment goal, non-dihydropyridine calcium channel blockers (diltiazem or verapamil) or beta-blockers would be more appropriate choices than amlodipine. 1 These agents have negative chronotropic effects that directly reduce heart rate. 3
The lack of heart rate effects with amlodipine may be advantageous in certain patient populations where heart rate reduction is not desired. 1 For example:
- Patients who already have adequate heart rate control
- Patients at risk for bradycardia
- Athletes or active individuals where heart rate reduction might impair exercise tolerance
Amlodipine can be safely combined with beta-blockers when both blood pressure control and heart rate reduction are needed. 1, 7 The JNC 7 guidelines list amlodipine as a standard dihydropyridine option for hypertension management. 3
Common Pitfall to Avoid
Do not confuse all calcium channel blockers as having the same effects on heart rate. The dihydropyridines (amlodipine, nifedipine, felodipine) produce marked peripheral vasodilation with little direct effect on heart rate, while non-dihydropyridines (diltiazem, verapamil) have significant heart rate-lowering effects. 3 This is a critical distinction when selecting appropriate therapy.