Untreated hypertension contributes to stroke, heart disease, and kidney disease and is a strong predictor of death associated with these conditions.1–3 Lowering blood pressure, regardless of the medication used, has been shown to reduce the risk of major cardiovascular events. The most important determinant for risk reduction is how much the blood pressure is lowered.
An 18-week prospective randomized double-blind Brazilian study compared 222 patients with moderate to severe hypertension (>160/95 mm Hg) taking a fixed dose combination of amlodipine and the ACE-inhibitor ramipril with 105 patients taking amlodipine monotherapy.4 Dosages of amlodipine were increased from 2.5 mg at baseline to 10 mg, based on interim blood pressure readings. Although the decrease in blood pressure with the combination therapy was significantly greater compared to monotherapy, amlodipine therapy alone resulted in average drops of office systolic blood pressure of 22.84 (standard deviation [SD] 1.33) mm Hg and of diastolic blood pressure of 14.64 (SD 0.75) mm Hg. Mean decreases in 24-hour ambulatory blood pressure readings between baseline and 18 weeks post-treatment initiation were 15.80 (SD 1.18) systolic and 8.61 (SD 0.74) mm Hg diastolic.
A prospective observational study of 4,277 patients with high blood pressure (>140/90 mm Hg) evaluated their blood pressure readings after amlodipine therapy of four to six months duration.5 2,982 received monotherapy (5 mg initially and increased to 10 mg if control not achieved after two months) and the rest received combination therapy with a variety of other antihypertensive regimens. The mean drop in systolic blood pressure was from 166.52 (SD 14.81) mm Hg initially to 134.46 (SD 30.66) at the final visit. Mean diastolic blood pressures went from 97.44 (SD 8.09) mm Hg initially to 79.09 (SD 18.28) at the final visit.
The CAMELOT study, a randomized control study of 1,991 patients with angiographically proven coronary artery disease but normal blood pressure (average BP 129/78 mm Hg at baseline) compared efficacy of amlodipine 10 mg or enalapril 20 mg with placebo in preventing cardiovascular events.6,7 There was a statistically significant drop in cardiovascular events and a moderate average drop in blood pressure of 4.8/2.5 mm Hg among the 663 patients taking amlodipine.
References
- Park CG. Is amlodipine more cardioprotective than other antihypertensive drug classes? Korean J Intern Med 2014; 29 (3): 301-304.
- Staessen JA, Li Y, Thijs L, Wang J-G. Blood pressure reduction and cardiovascular prevention: an update including the 2003-2004 secondary prevention trials. Hypertens Res 2005; 28 (5): 385-407.
- Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014; 32 (1): 3-15.
- Miranda RD, Mion DJ, Rocha JC, et al. An 18-week, prospective, randomized, double-blind, multicenter study of amlodipine/ramipril combination versus amlodipine monotherapy in the treatment of hypertension: the assessment of combination therapy of amlodipine/ramipril (ATAR) study. Clin Ther 2008; 30 (9): 1618-1628.
- Valcarcel Y, Jimenez R, Hernandez V, Aristegui R, Gil A. Efficacy and safety of amlodipine: a comparative study of hypertensive patients treated at primary- and specialised-care centres. Clin Drug Investig 2006; 26 (3): 125-133.
- Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure. JAMA 2004; 292 (18): 2217.
- Fares H, DiNicolantonio JJ, O’Keefe JH, Lavie CJ. Amlodipine in hypertension: A first-line agent with efficacy for improving blood pressure and patient outcomes. Open Heart 2016; 3 (2): 1-7. References
