Amlodipine blood pressure

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

DW, a 78-year-old Caucasian man, presents to the emergency room with complaints of a headache persisting over the last 3 days. Repeated blood pressure measurements average 200/11 0 mm Hg. He reports no other symptoms and physical examination and laboratory tests are unremarkable as is his past medical history with the exception of hypertension diagnosed in his early 60s. DW reports that he is struggling on a fixed retirement income with no prescription coverage and takes "what I can afford." Blood pressure medications are carvedilol 25 mg twice daily, amlodipine 10 mg once daily, torsemide (Demadex )... 

What are some treatment options, in addition to metoprolol 100 mg twice daily and amlodipine 10 mg daily, for JJ s elevated blood pressure ... 

Amlodipine is a calcium channel blocker used to treat hypertension and angina pectoris. Calcium channel blockers block the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates the veins that supply blood to them. This reduces blood pressure. 

Verapamil, diltiazem, and the dihydropyridine family (amlodipine, felodipine, isradipine, nicardipine, nifedipine, and nisoldipine) are all equally effective in lowering blood pressure, and many formulations are currently approved for this use in the USA. Clevidipine is a newer member of this group that is formulated for intravenous use only. 

Spontaneously hypertensive (SH) rats had higher (by 6%) blood plasma TAC than normal animals TAC correlated negatively with blood pressure in normal but not in hypertensive rats (N4). Other authors found no differences in TAC of blood plasma of SH rats as compared with normotensive rats. Lisinopril or amlodipine treatment did not affect TAC (M5). Another study found a negative correlation of TAC with blood pressure in normal but not SH rats (N5). 

Mibefradil is a tetralol derivative developed as a unique CCB. Its efficacy as an antihypertensive was demonstrated in phase III trials, where doses of 50 to 100 mg were compared to other CCBs (nifedipine SR, diltiazem CD, nifedipine GITS, amlodipine). Mibefradil was shown to be equally effective as or more effective than nifedipine SR, diltiazem CD, nifedipine GITS, or amlodipine in reducing blood pressure in mild to moderate hypertension. Average reductions of diastolic blood pressure of as much as 15 mmHg were seen with the 100-mg dose. It was also found to be effective in the treatment of chronic stable angina. Thus, it was indicated for use in hypertension and stable angina at doses of 50 or 100 mg once daily (15). 

These drugs inhibit Ca2+ ion transport across cell membranes and relax muscle tissues selectively without affecting the working of the heart. Hence high blood pressure can be reduced. Pfizer s amlodipine (Istin or Norvasc ) is a very important drug—it had sales of 1.6 billion dollars in 1996. 

Julius S, Kjeldsen SE, Weber M et al. (2004). Outcomes in hypertensive patients at high cardiovascular risk, treated with regimens based on valsartan or amlodipine the VALUE randomized trail. Lancet 363 2022-2031 Kearney PM, Welton M, Reynolds K et al. (2005). Global burden of hypertension analysis of worldwide data Lancet 365 217-223 Keli S, Bloemberg B, Kromhout D (1992). Predictive value of repeated systolic blood pressure measurements for stroke risk. 

While that particular combination isn t currently on the market, one product (Caduet) combines Lipitor (atorvastatin) for cholesterol lowering and Norvasc (amlodipine) for blood pressure reduction. Caduet is available in a wide variety of dosages of both agents, allowing physicians to choose the one that would best suit a particular patient. That s much better than a fixed combination, since typically one size does not fit all. 

Other sex-related differences in cardiovascular effect include the finding that antihypertensive drugs such as amlodipine exhibit greater antihypertensive effects in women than in men (119). Whether this greater response is due to differences in pharmacokinetics or pharmacodynamics is difficult to determine. Better blood pressure control could be explained by higher plasma drug concentrations in women, but pharmacokinetic differences do not necessarily correlate with the pharmacodynamic effects of antihypertensive drugs. 

Amlodipine has a t) (40 h) sufficient to permit the same benefits as the longest-acting formulations of rtifedipine without requiring a special formulation. Its slow association with L-channels and long duration of action render it unsuitable for emergency reduction of blood pressure where frequent dose adjustment is needed. On the other hand an occasional missed dose is of little consequence. Amlodipine differs from all other dihydropyridines listed in this chapter in being safe to use in patients with cardiac failure (the PRAISE Study). 

Mental stress is a risk factor for cardiovascular disease. In 24 patients with mild to moderate hypertension, amlodipine reduced the blood pressure rise during mental stress compared with placebo, but increased plasma noradrenaline concentrations (6). 

Ribbing s disease, which is characterized by multiple epiphyseal dystrophy. In a randomized, double-blind comparison of amlodipine (10 mg/day) and enalapril (20 mg/day) in 50 patients for 6 months, both drugs significantly reduced blood pressure, but amlodipine increased heart rate and plasma concentrations of noradrenaline and angiotensin II (7). These undesired effects make ACE inhibitors a better choice for prevention of cardiac dysfunction. 

A 35-year-old woman with benign intracranial hypertension and high blood pressure was given amlodipine, with good control of her blood pressure (8). However, her headache worsened and she developed papilledema. The CSF pressure was 30 cm. Her symptoms disappeared shortly after amlodipine withdrawal. 

A 48-year-old hypertensive physician, who had optimal blood pressure control after taking oral amlodipine 5 mg/day for 3 months, developed a slight frontal headache and fever, thought that he had malaria, and took four tablets of chloroquine sulfate (total 600 mg base). Two hours later he became nauseated and dizzy and collapsed his systolic blood pressure was 80 mmHg and his diastolic pressure was unrecordable, suggesting vasovagal syncope, which was corrected by dextrose-sahne infusion. 

The effect of sildenafil on arterial pressure has been tested in 16 hypertensive men taking amlodipine 5-10 mg/day (23). Sildenafil did not affect amlodipine pharmacokinetics, but caused a further additive fall in blood pressure. Adverse events with the combination of sildenafil and amlodipine, headache, dyspepsia, and nausea, did not require drug withdrawal. 

Cocco G, Ettlin T, Baumeler HR. The effect of amlodipine and enalapril on blood pressure and neurohumoral activation in hypertensive patients with Ribbing s disease (multiple epiphysal dystrophy). Clin Cardiol 2000 23(2) 109-14. 

Hypertensive patients taking amlodipine, in contrast to glyceryl trinitrate, had only a minor supplementary fall in blood pressure when challenged with a single dose of sildenafil, and a few had a mild to moderate headache (46). 

Potentiation by sildenafil of the hypotensive effects of glyceryl trinitrate and amlodipine has been investigated. The fall in systolic blood pressure with glyceryl trinitrate was amplified four-fold by sildenafil in healthy subjects. 

Of the CCBs, the nondihydropyradines (verapamil and dilti-azem) are the most effective because they lower heart rate in addition to lowering blood pressure. Nifedipine, because of its strong vasodilator properties, tends to cause hypotension and reflex tachycardia. In addition, nifedipine causes peripheral edema. These characteristics make it less useful in DHR Amlodipine is also effective because it reduces blood pressure. Initial doses are verapamil 120 to 240 mg/day, diltiazem 90 to 120 mg/day, and amlodipine 2.5 mg/day. 

Class II calcium channel blockers act primarily on smooth muscle cells and as such lead to dilation of blood vessels. This in turn reduces peripheral vascular resistance and they are used to reduce blood pressure. Examples are amlodipine and nifedipine. 

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