Should You Discontinue Amlodipine?
No, you should not discontinue amlodipine in this patient with hypertension, history of open heart surgery, cardiomegaly, and chronic kidney disease—amlodipine is specifically indicated and beneficial for this clinical profile. 1
Rationale for Continuing Amlodipine
Cardiovascular Protection in High-Risk Patients
Amlodipine is explicitly safe in patients with coronary heart disease and has demonstrated no increased risk of adverse cardiac events, making it appropriate for patients with cardiac surgical history 1
The American Heart Association recommends amlodipine as a safe option even in patients with severe heart failure, as it does not worsen heart failure symptoms (PRAISE trial) 1
For patients with cardiomegaly and left ventricular dysfunction, amlodipine has been shown to improve left ventricular ejection fraction, reduce symptoms, and enhance exercise capacity when added to standard therapy including ACE inhibitors 2
Renal Protection in CKD
Amlodipine displays renoprotective effects in CKD patients, particularly when paired with ACE inhibitors or ARBs 3
Studies demonstrate that amlodipine reduces renal artery smooth muscle contraction, leading to higher renal blood flow even while systemic blood pressure is reduced 3
A 3-year randomized trial showed amlodipine decreased renal function decline in hypertensive patients with non-diabetic nephropathies 1
In hypertensive patients with renal dysfunction, amlodipine significantly decreased blood pressure while causing little or no aggravation of renal dysfunction 4
Even a single dose of amlodipine can lead to demonstrable increases in estimated glomerular filtration rate in CKD patients 3
Safety Profile in Complex Cardiac Patients
Amlodipine has neutral effects on morbidity and mortality in large randomized controlled trials and may be considered for management of hypertension or ischemic heart disease in patients with heart failure 3
The drug does not cause cardiac conduction disturbances, postural hypotension, or adverse changes in serum lipid patterns that are problematic with other cardiovascular agents 5
The American College of Cardiology recommends calcium channel blockers including amlodipine for ischemic symptoms when beta-blockers are contraindicated or cause unacceptable side effects 1
Important Considerations
Gradual Discontinuation if Necessary
If discontinuation were ever required, amlodipine must be tapered gradually over 7-10 days due to its long elimination half-life (40-60 hours) and steady-state accumulation 6
Abrupt discontinuation could theoretically cause rebound hypertension, though amlodipine shows no evidence of significant rebound effect when properly tapered 6
Monitoring Parameters
Continue monitoring blood pressure to ensure adequate control (target <160/100 mmHg in most guidelines) 3
Monitor renal function (serum creatinine and estimated glomerular filtration rate) periodically, though amlodipine is unlikely to worsen kidney function 4, 7
Watch for peripheral edema (the most common side effect), which is related to vasodilatory action and generally mild to moderate 5
Contraindications to Consider
The only absolute contraindications would be severe aortic stenosis or hypertrophic cardiomyopathy with outflow obstruction, where vasodilatory effects require caution 1
Your patient's profile (post-cardiac surgery, cardiomegaly, CKD, hypertension) represents ideal indications for amlodipine, not contraindications 1, 7
Clinical Bottom Line
Discontinuing amlodipine in this patient would remove a medication that provides blood pressure control, cardiovascular protection, and renal preservation—all critical for someone with this complex cardiac and renal history. 1, 7 Unless there is a specific adverse effect (such as intolerable edema) or a new contraindication has developed, continuing amlodipine is the evidence-based approach. 3, 2