Amlodipine in the current management of hypertension

Abstract

Hypertension is the leading cause of death worldwide, affecting 1.4 billion people. Treatment options include the widely used calcium channel blockers, among which amlodipine, a dihydropyridine, has unique characteristics that distinguish it from other drugs within this class. This review aims to provide an updated overview of the evidence supporting the use of amlodipine over the past 30 years and highlights its cardiovascular benefits in current hypertension management. Amlodipine has low renal clearance (7 mL/min/mg) and long half-life (35-50 h) and duration of action, which allows it to sustain its anti-hypertensive effect for more than 24 h following a single dose. Additionally, blood pressure (BP) control is maintained even when a dose has been missed, providing continuous protection in case of incidental noncompliance. It has proven to reduce BP variability and successfully lower BP. Amlodipine also controls BP in patients with a systolic/diastolic BP of 130/80 mm Hg or higher, diabetes, or chronic kidney disease without worsening glycemic or kidney function. Additionally, amlodipine is a wise choice for older adults due to its ability to control BP and protect against stroke and myocardial infarction. Side effects of amlodipine include edema, palpitations, dizziness, and flushing, which are more common with the higher dose of 10 mg. Amlodipine is cost effective and predicted to be cost saving when compared with usual care.

Keywords: amlodipine; blood pressure variability; calcium channel blockers; hypertension.

FIGURE 1

Meta‐analysis of antihypertensive drug effects on long‐term BPV. (A) Change in group variation in SBP at follow‐up compared with baseline as variance ratio. (B) Percentage increase in coefficient of variation. Error bars represent the 95% confidence intervals. A is plotted on a logarithmic scale. The apparent increase in variance ratio and coefficient of variation (CV) from baseline to follow‐up was mainly a consequence of the requirement in many trials for narrow ranges of BP at randomization, which tended to lead to an increase in group standard deviation on follow‐up; however, this effect applied almost equally to all drug classes. AB, α−1 blocker; ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin‐2‐receptor blocker; BB, β‐blocker; CCB, calcium channel blocker; CCBND, non‐dihydropyridine calcium channel blocker; DD, non‐loop diuretic drug. Reprinted with permission from Webb.