Is a combination tablet of losartan (angiotensin II receptor antagonist) and amlodipine (calcium channel blocker) available for a patient with hypertension and possible diabetic nephropathy?

Combination Tablet Availability

Yes, fixed-dose combination tablets containing losartan (an ARB) and amlodipine (a calcium channel blocker) are available and are specifically recommended by current guidelines for patients requiring dual antihypertensive therapy. 1

Guideline Support for Fixed-Dose Combinations

The 2024 ESC Guidelines explicitly recommend fixed-dose single-pill combination treatment for patients receiving combination blood pressure-lowering therapy, as this approach improves medication adherence and simplifies treatment regimens. 1

• Preferred combination strategy: A RAS blocker (either ACE inhibitor or ARB like losartan) combined with a dihydropyridine calcium channel blocker (like amlodipine) is one of the recommended first-line dual therapy options. 1

• Single-pill combinations are superior: Fixed-dose combinations improve treatment adherence compared to taking multiple separate pills, which is critical for achieving blood pressure targets. 1

Specific Relevance for Diabetic Nephropathy

For your patient with hypertension and possible diabetic nephropathy, this combination is particularly appropriate:

• ARB as foundation: Losartan (or another ARB) is recommended as first-line therapy for patients with diabetes and albuminuria (UACR ≥300 mg/g) to reduce progression of kidney disease. 1

• Adding amlodipine for BP control: Most patients with diabetes require multiple drugs to achieve the target BP of <130/80 mmHg. 1 The combination of losartan plus amlodipine has been specifically studied and proven effective in diabetic hypertensive patients. 2

• Clinical trial evidence: The ADHT trial demonstrated that adding amlodipine to losartan monotherapy in diabetic hypertensive patients achieved BP goals in 27.5% versus only 12.5% with placebo, reducing BP by an additional 8.1/5.4 mmHg. 2

Clinical Algorithm for This Patient

Step 1: Confirm albuminuria status (UACR measurement)

• If UACR ≥300 mg/g: Losartan is strongly recommended as first-line agent 1
• If UACR 30-299 mg/g: Losartan is suggested to prevent progression 1

Step 2: If BP remains ≥140/90 mmHg on losartan monotherapy, add amlodipine 1

Step 3: Use fixed-dose combination tablet (losartan/amlodipine) to improve adherence 1

Step 4: If BP still not controlled with dual therapy, add a thiazide-like diuretic (preferably as a three-drug single-pill combination) 1

Important Caveats

• Never combine two RAS blockers: Do not combine losartan with an ACE inhibitor or direct renin inhibitor, as this increases adverse events (hyperkalemia, acute kidney injury) without additional cardiovascular benefit. 1

• Monitor renal function: Check serum creatinine and potassium within 7-14 days after initiating or titrating losartan, then at least annually. 1

• Target BP: Aim for 120-129 mmHg systolic if well tolerated, or at minimum <130/80 mmHg in diabetic patients. 1