What is a good combination with amlodipine (Blood Pressure) for blood pressure control?

From the Guidelines

For blood pressure control, a good combination with amlodipine is an ACE inhibitor, such as lisinopril 10-40mg daily, or an ARB, like losartan 50-100mg daily, as these combinations have been shown to be effective in achieving target blood pressure levels 1.

Key Considerations

• These combinations work well because they target different blood pressure mechanisms - amlodipine blocks calcium channels in blood vessels while ACE inhibitors/ARBs block the renin-angiotensin system.
• For patients with certain comorbidities, specific combinations may be preferred: ACE inhibitors/ARBs for diabetic patients or those with kidney disease, and diuretics for patients with fluid retention.
• If adding a second agent doesn't achieve target BP, a three-drug combination including amlodipine, an ACE inhibitor/ARB, and a diuretic is often effective.

Monitoring and Side Effects

• Monitor for potential side effects like hypotension, electrolyte disturbances, or edema when using combination therapy.
• Regular review of the patient's blood pressure and adjustment of the treatment regimen as needed is crucial to achieve optimal blood pressure control.

Evidence-Based Recommendations

• The guidelines suggest that the combination of amlodipine with an ACE inhibitor or ARB is a preferred option for the treatment of hypertension 1.
• The use of fixed-dose combinations can simplify treatment schedules and improve patient compliance 1.

From the FDA Drug Label

This inhibition of coronary spasm is responsible for the effectiveness of amlodipine in vasospastic (Prinzmetal's or variant) angina. Following administration of therapeutic doses to patients with hypertension, amlodipine produces vasodilation resulting in a reduction of supine and standing blood pressures. In clinical studies in which amlodipine was administered in combination with beta-blockers to patients with either hypertension or angina, no adverse effects on electrocardiographic parameters were observed. Sildenafil: When amlodipine and sildenafil were used in combination, each agent independently exerted its own blood pressure lowering effect [see Drug Interactions ( 7.1)] .

The combination of amlodipine with other medications such as beta-blockers or sildenafil can be effective for BP control.

• Amlodipine can be used in combination with beta-blockers without adverse effects on electrocardiographic parameters.
• Amlodipine and sildenafil can be used together, with each agent exerting its own blood pressure lowering effect 2. However, it is essential to consider the potential interactions between amlodipine and other medications, such as CYP3A inhibitors, which may increase the plasma concentrations of amlodipine.

From the Research

Combination Therapy with Amlodipine for BP Control

• The use of combination therapy, including amlodipine, is a common approach for managing hypertension, as more than 70% of adults treated for primary hypertension will eventually require at least two antihypertensive agents 3.
• Studies have shown that combining amlodipine with other antihypertensive agents, such as lisinopril, losartan, or valsartan, can be effective in reducing blood pressure and improving arterial stiffness in patients with essential hypertension 4.
• A fixed-dose combination of perindopril and amlodipine has been shown to be safe and effective in reducing blood pressure and achieving blood pressure control in patients with hypertension 5.
• The addition of amlodipine to monotherapy with quinapril or losartan has been found to be effective in reducing blood pressure and achieving target blood pressure goals in patients with hypertension and diabetes 6.
• A comparative study found that combination therapy with losartan, amlodipine, and hydrochlorothiazide was effective in managing stage 2 hypertension, with the combination of amlodipine and losartan showing significant reductions in systolic and diastolic blood pressure 7.

Key Findings

• Combination therapy with amlodipine can be an effective approach for managing hypertension, particularly in patients who require multiple antihypertensive agents.
• The choice of combination therapy should be based on individual patient characteristics, such as the presence of diabetes or kidney disease.
• Amlodipine can be safely combined with other antihypertensive agents, including ACE inhibitors, ARBs, and diuretics.
• The use of fixed-dose combinations, such as perindopril and amlodipine, can simplify treatment regimens and improve patient compliance.