Combination Therapy for Hypertension

Guideline-Endorsed Combination

The European Society of Hypertension/European Society of Cardiology recommends the combination of a calcium antagonist (amlodipine) and an angiotensin receptor antagonist (valsartan) as an effective and well-tolerated two-drug combination for hypertension 1
The combination of amlodipine and valsartan has complementary mechanisms of action, with amlodipine blocking calcium channels causing vasodilation, and valsartan blocking the renin-angiotensin system, providing additive blood pressure reduction 2

The VALUE trial, involving over 15,000 high-risk hypertensive patients, demonstrated that early blood pressure reduction matters, with the greater blood pressure reduction with amlodipine in the first 6 months accompanied by fewer cardiovascular events, emphasizing the importance of achieving rapid control 2, 1
The VALUE trial also showed that amlodipine-based regimens achieved slightly lower blood pressure, but there was no significant difference in the primary outcome of cardiac events and death between valsartan-based and amlodipine-based regimens 3, 4

The American Heart Association, as reported in Circulation, notes that the combination of amlodipine and valsartan is effective in patients with coronary artery disease and hypertension, addressing both blood pressure control and providing cardiovascular protection 5

The American College of Cardiology, as reported in Circulation, recommends avoiding the combination of amlodipine and valsartan in pregnancy, history of angioedema with ARBs, severe bilateral renal artery stenosis, and combination with ACE inhibitors (dual RAAS blockade increases risk without benefit) 6, 1
The American College of Cardiology, as reported in Circulation, also recommends monitoring for hyperkalemia, particularly in patients with chronic kidney disease or those on potassium supplements 6