Incremental Blood Pressure–Lowering Effect of Titrating Amlodipine for the Treatment of Hypertension in Patients Including Those Aged ≥55 Years

Jeffers, Barrett W.; Bhambri, Rahul; Robbins, Jeffery

doi:10.1097/mjt.0000000000000142

Cited by 2 publications

(5 citation statements)

References 49 publications

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“…In the study by Smith, et al [34] heart failure and black race had 73% and 63% more likelihood to have resistant hypertension, and patients with resistant hypertension had higher risk of adverse outcomes including all-cause death. In our cohort, it is likely that stepping up the dose of amlodipine and lisinopril would further increase the number of patients that will achieve BP control, as found from previous research [35,36]. Of note, there was room to step up both drugs as both were started at low doses.…”

Section: Discussionmentioning

confidence: 57%

Amlodipine or Lisinopril in Combination with Bendroflumethiazide in Clinic Blood Pressure Control among Hypertensive Tanzanians with Moderate to Severe Hypertension: A Comparison Study

Pilly¹,

Ritha²,

Appolinary³

2021

J Hypertens Manag

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Background: Recent guidelines have suggested combination therapy as initial treatment in hypertensive patients with ≥ grade 2 hypertension, aiming to achieve target blood pressure (BP) goal faster and more effectively. Both calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEIs) are in the list of first-line antihypertensives, however the choice of the combination therapy is left to the discretion of the clinician, and there are concerns that ACEIs are less effective in BP reduction among black hypertensives. We aimed to study the BP lowering effect after 4 weeks of treatment with Amlodipine (CCB) and Lisinopril (ACEI) each in combination with Bendroflumethiazide (thiazide diuretic) among adult hypertensive patients with ≥ grade 2 hypertension attending 3 district hospitals in Dar-es-Salaam, Tanzania. Methods:We conducted a comparative study from November 2018 to January 2019. Eligible patients received Amlodipine/Bendroflumethiazide (5/5 mg) or Lisinopril/Bendroflumethiazide (5/5 mg) drug combinations. The primary outcome measure was the BP level after 4 weeks of treatment compared to baseline BP.Results: A total of 239/266 (89.8%) patients (121 Amlodipine, 118 Lisinopril) completed the study. Their mean age was 60 ± 12 years and 69% were females. The mean ± SD baseline BP was 173 ± 19/101 ± 15 mmHg for Amlodipine and 169 ± 15/101 ± 11 mmHg for Lisinopril groups, p = 0.088. After 4 weeks of treatment, the BP dropped by a mean of 43/22 mmHg and 40/22 mmHg in the Amlodipine and Lisinopril groups, respectively (p > 0.05). Overall, after 4 weeks of treatment majority (85.4%) of study participants in the total population achieved BP control (86.0% in Amlodipine, 84.7% in Lisinopril, p = 0.792). Conclusion:Both Amlodipine and Lisinopril each in combination with Bendroflumethiazide showed impressive BP reductions in this cohort of native Tanzanian patients with ≥ stage 2 hypertension, and there was an insignificant difference between them. Both drug combinations can be used in the initial treatment plan when the priority is to reduce one's BP.

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Section: Discussionmentioning

confidence: 57%

Amlodipine or Lisinopril in Combination with Bendroflumethiazide in Clinic Blood Pressure Control among Hypertensive Tanzanians with Moderate to Severe Hypertension: A Comparison Study

Pilly¹,

Ritha²,

Appolinary³

2021

J Hypertens Manag

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“…In the kidneys, Amlodipine decreases glomerular resistance, increases renal blood, decreases the activity of renin and thus increases glomerular filtration rate to a small extent, but whether these actions persist in a long term treatment is still debatable. However, Amlodipine has been the preferred drug of choice for hypertension and angina for many years because of its favorable pharmacodynamic and pharmacokinetic properties [25][26][27][28][29][30][31][32][33][34] .…”

Section: Amlodipine: a Pharmacology: Amlodipine Is A Classicmentioning

confidence: 99%

“…Common: Peripheral edema, flushing, headache, dizziness, nausea, dyspnea, abdominal pain, dyspepsia, constipation [32][33][34] .…”

Section: Adverse Reactionmentioning

confidence: 99%

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2019

IJPSR

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The calcium channel blockers, a diverse group of cardiovascular drugs, exert their action by inhibiting the L-type calcium channels and cause vasodilatation in the heart and the smooth muscles. They also block the action potential at the SA and AV node, thus prolonging the duration of the action potential (Verapamil and Diltiazem). Although, the calcium channel blockers have the same anti-hypertensive actions, they have a vast difference in their pharmacological actions, pharmacokinetic profile, and adverse reactions. The main aim was to review, compare, and understand the complete pharmacological profile of all the calcium channel blockers and understand their place in pharmacotherapy. Numerous articles and studies showed that amlodipine remains to be the safe and effective drug of choice in chronic hypertension due to its slow, prolonged duration of action and lesser incidence of reflux tachycardia. The newer calcium channel blockers, although similar to amlodipine in blood pressure lowering effect, have several pharmacological advantages. Felodipine was found to be slightly better than amlodipine in the treatment of ischemia/angina due to its high pre-load reducing the effect. Lercanidipine was found to be a better reno-protective agent than amlodipine due to its actions in the kidney. Benidipine was found to be an excellent, antiatherosclerotic, and reno-protective agent. The incidence of baroreceptor activation and pedal edema was also found to be lower in the newer calcium channel blockers. Hence, the new generation calcium channel blockers could be preferred for various cardiovascular problems. 2. General Pharmacology: A high cytosolic calcium concentration causes increased contraction of the heart and the vascular smooth muscles 3. Calcium generally enters the cell via the slow Ltype calcium channels from the extracellular fluid into the cytosol, which causes an increased release of calcium from the sarcoplasmic reticulum and

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Incremental Blood Pressure–Lowering Effect of Titrating Amlodipine for the Treatment of Hypertension in Patients Including Those Aged ≥55 Years

Cited by 2 publications

References 49 publications

Amlodipine or Lisinopril in Combination with Bendroflumethiazide in Clinic Blood Pressure Control among Hypertensive Tanzanians with Moderate to Severe Hypertension: A Comparison Study

Amlodipine or Lisinopril in Combination with Bendroflumethiazide in Clinic Blood Pressure Control among Hypertensive Tanzanians with Moderate to Severe Hypertension: A Comparison Study

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