From the Guidelines
For uncontrolled blood pressure while already taking amlodipine 10mg, the current treatment regimen should be optimized, including health behavior change and diuretic-based treatment, before considering the addition of other medications. According to the 2020 international society of hypertension global hypertension practice guidelines 1, if seated office BP >140/90 mm Hg in patients managed with three or more antihypertensive medications at optimal (or maximally tolerated) doses including a diuretic, one should first exclude causes of pseudoresistance and substance-induced increases in BP.
Optimizing Current Treatment Regimen
The following steps can be taken to optimize the current treatment regimen:
- Ensure the patient is taking amlodipine consistently
- Reduce sodium intake
- Exercise regularly
- Maintain a healthy weight
- Limit alcohol
- Manage stress
- Consider adding a diuretic, such as a thiazide diuretic, to the treatment regimen if not already included
Adding Additional Medication
If the blood pressure remains uncontrolled despite optimizing the current treatment regimen, adding a low dose of spironolactone as the 4th line agent can be considered in those whose serum potassium is <4.5 mmol/L and whose eGFR is >45 ml/min/1.73m2 1. Alternatively, other medications such as amiloride, doxazosin, eplerenone, clonidine, and beta-blockers can be considered if spironolactone is contraindicated or not tolerated.
Monitoring and Follow-up
Blood pressure should be monitored regularly at home, and the patient should follow up with their healthcare provider within 2-4 weeks after any medication changes. If blood pressure remains uncontrolled despite these measures, the provider might consider other combinations or investigate secondary causes of hypertension. The ALLHAT trial 1 compared the effectiveness of different antihypertensive medications, but the most recent guidelines from 2020 1 provide the best evidence for managing uncontrolled blood pressure.
From the FDA Drug Label
1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
Many patients will require more than one drug to achieve blood pressure goals.
The dose of 10mg of amlodipine is used for the treatment of uncontrolled blood pressure as part of a comprehensive management plan, which may include other medications and lifestyle modifications.
- The primary goal is to lower blood pressure and reduce the risk of cardiovascular events.
- Amlodipine may be used alone or in combination with other antihypertensive agents.
- The choice of therapy should be guided by published guidelines and individual patient needs 2.
- In some cases, patients may require more than one medication to achieve adequate blood pressure control.
- It is essential to monitor blood pressure regularly and adjust the treatment plan as needed to achieve optimal control 2.
From the Research
Uncontrolled Blood Pressure and Amlodipine 10mg
- Amlodipine is a dihydropyridine calcium channel blocker that has been widely used for the treatment of hypertension 3.
- The efficacy of amlodipine in lowering blood pressure has been demonstrated in several studies, including a study that showed significant reductions in ambulatory 24-h, daytime, and nighttime systolic blood pressure, and pulse pressure in patients with uncontrolled hypertension 4.
- Amlodipine 10mg has been shown to be effective in reducing blood pressure in patients who had not responded to 5mg, with a statistically significant decrease in blood pressure from baseline observed in patients aged either younger than 55 years or 55 years or older 5.
- The use of amlodipine as a first-line agent for the treatment of hypertension is supported by its efficacy and safety profile, as well as strong evidence from large randomized controlled trials for cardiovascular event reduction 3.
- In patients with uncontrolled hypertension, the addition of amlodipine to other antihypertensive agents, such as perindopril and indapamide, has been shown to be effective in reducing blood pressure and improving blood pressure control 4.
Comparison with Other Antihypertensive Agents
- Amlodipine has been compared to other antihypertensive agents, including thiazide diuretics, ACE inhibitors, and beta-blockers, and has been shown to be at least as effective as these agents in lowering blood pressure 6, 7.
- The choice of antihypertensive agent depends on various factors, including the patient's age, comorbidities, and concomitant medications, as well as the agent's efficacy and safety profile 6.
Dosing and Titration
- The dosing of amlodipine can be titrated from 5mg to 10mg to achieve optimal blood pressure control, with significant decreases in blood pressure observed in patients who were uptitrated to 10mg 5.
- The efficacy and safety of amlodipine 10mg have been demonstrated in patients aged 55 years or older, as well as in younger patients, with similar results observed in both age groups 5.