Expected Blood Pressure Reduction with Amlodipine 5mg
Amlodipine 5mg can be expected to lower blood pressure by approximately 9/5 mmHg on office measurements and 5/3 mmHg on ambulatory blood pressure monitoring (ABPM). 1
Magnitude of BP Reduction
The 2024 ESC guidelines provide the most authoritative and recent data on expected BP reductions with standard-dose calcium channel blockers like amlodipine 1:
- Office BP reduction: Approximately 9 mmHg systolic / 5 mmHg diastolic 1
- Ambulatory BP reduction: Approximately 5 mmHg systolic / 3 mmHg diastolic 1
- These reductions apply to standard doses across the five main antihypertensive drug classes, with similar overall efficacy 1
Real-World Evidence Supporting These Estimates
Research data corroborate these guideline estimates:
- A systematic review of amlodipine monotherapy in over 5,000 patients demonstrated a mean systolic BP reduction of 17.5 mmHg from baseline, with a median daily dose of 5mg 2
- An 8-week real-world study from India showed that amlodipine 5-10mg/day produced significant reductions in both office and 24-hour ambulatory BP measurements (p<0.0001) 3
- A comparative trial found amlodipine 5mg (titrated to 10mg as needed) reduced BP by approximately 14.0/7.1 mmHg over 12 weeks 4
Important Clinical Considerations
Time to Maximum Effect: The BP-lowering effect typically becomes evident within 1-2 weeks, but maximum effect may take longer to manifest 1. The ESC guidelines recommend follow-up at 1-3 months (preferably 1 month) to assess the full BP-lowering effect 1.
Dose-Response Relationship: The BP-lowering effect increases with dose, though not linearly 1. If 5mg is insufficient, titration to 10mg will provide additional BP reduction 5, 6.
Patient-Specific Variations:
- Elderly patients and isolated systolic hypertension: Greater BP reductions are typically observed in patients ≥60 years and those with isolated systolic hypertension 2
- Baseline BP matters: The magnitude of BP reduction increases as a function of pre-treatment BP (Wilder's principle) 1
Practical Application
When initiating amlodipine 5mg, anticipate:
- A reduction of roughly 10/5 mmHg in most patients with mild-to-moderate hypertension 1
- Greater reductions (potentially 15-20 mmHg systolic) in elderly patients or those with higher baseline BP 2
- The need for combination therapy if the goal is to achieve BP reductions exceeding 20/10 mmHg, as combination therapy with three drugs at half-standard dose can lower office BP by up to 20/11 mmHg 1
Common Pitfall: Do not expect immediate maximal effect—allow at least 1 month before concluding that dose escalation or additional agents are needed 1.