Amlodipine ace inhibitor
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Amlodipine and ACE Inhibitors: Synergistic Effects and Clinical Benefits
Introduction to Amlodipine and ACE Inhibitors
Amlodipine, a calcium channel blocker, and angiotensin-converting enzyme (ACE) inhibitors are commonly used medications for managing hypertension and heart failure. Recent studies have explored the combined use of these drugs, revealing significant benefits in terms of efficacy and side effect profiles.
Efficacy in Hypertension Management
Combination Therapy vs. Monotherapy
Research comparing combination therapy of amlodipine with ACE inhibitors to high-dose calcium antagonist monotherapy has shown that the combination is equally effective in lowering diastolic blood pressure. However, it significantly reduces the incidence of dose-dependent adverse effects such as vasodilatory edema. This suggests that combining these medications can achieve optimal blood pressure control with fewer side effects.
Long-term Renoprotection
A one-year prospective study demonstrated that amlodipine is comparable to ACE inhibitors like enalapril in terms of long-term renoprotection for hypertensive patients with renal dysfunction. Both treatments showed similar reductions in blood pressure and comparable effects on serum creatinine and creatinine clearance, with amlodipine being better tolerated.
Synergistic Effects on Myocardial Oxygen Consumption
Mechanisms of Action
Studies have shown that amlodipine and ACE inhibitors work synergistically to regulate myocardial oxygen consumption. This is achieved through the modulation of kinin-mediated nitric oxide (NO) release, which is crucial for reducing myocardial oxygen demand. The combination of sub-threshold doses of ramiprilat (an ACE inhibitor) and amlodipine resulted in a more significant reduction in myocardial oxygen consumption compared to either drug alone .
Enhanced NO Production
Further research has confirmed that amlodipine enhances NO production induced by ACE inhibitors through a kinin-mediated mechanism. This synergistic effect on NO formation contributes to the therapeutic benefits of these drugs in treating heart disease, particularly heart failure .
Clinical Benefits in Heart Failure
Improved Hemodynamics and Neurohormonal Activity
In models of congestive heart failure (CHF), the combination of amlodipine and ACE inhibitors has shown greater benefits compared to monotherapy. This includes improved left ventricular function, reduced systemic vascular resistance, and normalized neurohormonal activity, which are critical factors in managing CHF.
Reduction in Cardiovascular Events
A large-scale clinical trial comparing the combination of benazepril (an ACE inhibitor) and amlodipine to benazepril and hydrochlorothiazide found that the former combination was more effective in reducing the rate of cardiovascular events. This highlights the superior efficacy of the ACE inhibitor and calcium channel blocker combination in high-risk hypertensive patients.
Conclusion
The combination of amlodipine and ACE inhibitors offers significant advantages over monotherapy in managing hypertension and heart failure. This synergy not only enhances blood pressure control and myocardial oxygen consumption but also reduces adverse effects and improves long-term outcomes. These findings support the use of combination therapy as a more effective and safer option for patients with cardiovascular conditions.
Sources and full results
Most relevant research papers on this topic