Management of Hypertension and Coronary Artery Disease with Amlodipine

Introduction to Amlodipine Therapy

Dihydropyridine calcium channel blockers like amlodipine are considered appropriate drugs of choice for patients with stable angina and coronary artery disease, according to the American Heart Association 1, 2
In patients with hypertension and stable coronary artery disease, dihydropyridine CCBs can be added to the basic regimen of β-blocker, ACE inhibitor, and thiazide diuretic if either angina or hypertension remains uncontrolled, as recommended by the American College of Cardiology 2

First-line therapy should include a β-blocker (especially with prior myocardial infarction), ACE inhibitor or ARB (particularly with prior myocardial infarction, left ventricular dysfunction, diabetes, or chronic kidney disease), and thiazide or thiazide-like diuretic, as suggested by the American Heart Association 2
If blood pressure remains uncontrolled, adding a long-acting dihydropyridine CCB like amlodipine at appropriate dosing (5-10mg once daily) is recommended by the American College of Cardiology 2

For patients with coronary artery disease, the target blood pressure is <140/90 mmHg (Class IIa; Level of Evidence B), according to the American Heart Association 4
A lower target (<130/80 mmHg) may be considered in some individuals with coronary artery disease, previous stroke, or coronary artery disease risk equivalents (Class IIb; Level of Evidence B), as recommended by the American College of Cardiology 4
Combining non-dihydropyridine CCBs with β-blockers should be used with caution due to increased risk of bradyarrhythmias and heart failure, as noted by the American Heart Association 2

In patients with heart failure and reduced ejection fraction, non-dihydropyridine CCBs (verapamil and diltiazem) should be avoided, according to the American College of Cardiology 5
For patients with hypertension and heart failure with preserved ejection fraction, dihydropyridine CCBs may be effective to minimize symptoms, as suggested by the American Heart Association 5
In elderly patients, monitoring for orthostatic changes and avoiding excessively low diastolic blood pressure (<65 mmHg) is recommended by the American Geriatrics Society 6