Blood Pressure Reduction: Amlodipine 5mg vs 10mg
Amlodipine 10mg provides approximately 4-6 mmHg greater systolic blood pressure reduction compared to 5mg, with dose-dependent efficacy clearly demonstrated across multiple trials. 1, 2, 3
Magnitude of Blood Pressure Reduction
Amlodipine 5mg
- Produces average blood pressure reductions of approximately 12/6 mmHg (standing) and 13/7 mmHg (supine) from baseline 1
- Achieves target blood pressure in approximately 56% of patients with mild to moderate hypertension 3
- Represents the minimum effective dose for most patients with hypertension 2
Amlodipine 10mg
- Delivers significantly greater blood pressure reduction than 5mg, with dose-related efficacy consistently demonstrated 2, 3
- Achieves target blood pressure in approximately 73% of patients, compared to 56% with 5mg 3
- In dose-ranging studies, the 10mg dose produced statistically significant reductions in both supine and standing blood pressures compared to lower doses after 4 weeks of treatment 2
Clinical Implications for Dosing Strategy
Start with amlodipine 5mg once daily and titrate to 10mg after 2-4 weeks if blood pressure remains above target. 1, 2, 3
Initial Dosing Approach
- Begin with 5mg once daily as the recommended starting dose for most patients 1, 4
- This approach minimizes vasodilatory side effects (particularly peripheral edema) while providing effective blood pressure control in over half of patients 2, 3
Dose Titration
- If blood pressure target is not achieved after 4 weeks on 5mg, increase to 10mg once daily 2, 3
- The dose-response relationship is clear and clinically meaningful, justifying this simple two-step approach 2, 3
- No tolerance develops with long-term use at either dose 1, 4
Tolerability Considerations
The 10mg dose maintains excellent tolerability despite greater efficacy, though peripheral edema occurs slightly more frequently. 1, 2, 3
- Side effects remain mild to moderate at both doses 2, 3
- Peripheral edema occurs in approximately 10.5% of patients overall, with slightly higher rates at 10mg 5
- No clinically significant effects on heart rate, ECG, or body weight at either dose 2, 3
- The long half-life ensures smooth 24-hour blood pressure control without orthostatic hypotension at both doses 1, 6
When to Choose Combination Therapy Over Dose Escalation
If blood pressure remains uncontrolled on amlodipine 10mg monotherapy, add a second agent from a different class rather than exceeding 10mg. 7
- Most patients with hypertension require two or more medications to achieve target blood pressure, particularly those with grade 2-3 hypertension or high cardiovascular risk 7
- Preferred combinations include amlodipine with ACE inhibitors, ARBs, or thiazide diuretics, which provide complementary mechanisms of action 7, 4
- Combination therapy at lower doses often provides better tolerability than maximum-dose monotherapy 7