Amlodipine affect heart rate
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The Impact of Amlodipine on Heart Rate: A Comprehensive Review
Introduction to Amlodipine and Heart Rate
Amlodipine, a calcium channel blocker, is widely used to manage hypertension and angina pectoris. Its effects on heart rate (HR) are of significant interest, particularly in patients with cardiovascular conditions. This article synthesizes findings from multiple studies to elucidate how amlodipine influences heart rate.
Amlodipine and Heart Rate Variability (HRV)
Influence on HRV Parameters
Research indicates that amlodipine does not significantly alter most heart rate variability (HRV) time domain parameters. However, it does reduce the low-high frequency ratio, suggesting a shift towards increased vagal activity, which is beneficial for autonomic balance. This shift indicates a reduction in sympathetic nervous system activity, which can be advantageous for cardiovascular health.
Hemodynamic Effects and Heart Rate
Acute and Chronic Effects
Amlodipine has been shown to increase heart rate slightly in the short term. In a study involving intravenous administration of 10 mg amlodipine, heart rate increased from 75 to 80 beats per minute within 15 minutes. This increase is accompanied by a decrease in systemic vascular resistance and mean arterial pressure, highlighting its vasodilatory effects.
Comparison with Other Calcium Channel Blockers
When compared to nifedipine, another calcium channel blocker, amlodipine demonstrates a more favorable profile in terms of sympathetic nerve activity. Amlodipine reduces plasma and urinary norepinephrine levels, indicating lower sympathetic activation, which is not observed with short-acting nifedipine. This reduction in sympathetic activity is beneficial for long-term cardiovascular outcomes.
Circadian Rhythms and Dosing Time
Morning vs. Evening Dosing
The timing of amlodipine administration can influence its effects on heart rate and blood pressure. Morning dosing of amlodipine is associated with a more significant reduction in nocturnal blood pressure and a better overall circadian blood pressure profile compared to evening dosing. This suggests that the timing of administration can optimize its therapeutic effects.
Effects in Animal Models
Telemetric Studies in Rats
In animal studies, amlodipine has shown a dose-dependent increase in heart rate, with more pronounced effects during the light phase of the circadian cycle. This phase-dependency highlights the importance of considering circadian rhythms in the administration of amlodipine.
Clinical Implications
Myocardial Ischemia and Heart Rate
Amlodipine has been found to reduce ischemia-induced ventricular conduction delays and improve myocardial function during reperfusion in ischemic conditions . These effects are achieved without significant alterations in heart rate, suggesting that amlodipine can protect myocardial tissue without adverse effects on heart rate.
Long-Term Cardiovascular Benefits
Long-term administration of amlodipine does not induce reflex tachycardia, a common side effect of some vasodilators. This makes it a suitable option for patients with hypertension and angina pectoris, providing effective blood pressure control and angina relief without compromising heart rate stability.
Conclusion
Amlodipine exerts a complex influence on heart rate, characterized by a slight acute increase but overall beneficial effects on autonomic balance and sympathetic activity. Its impact varies with dosing time and is favorable compared to other calcium channel blockers. These properties make amlodipine a valuable therapeutic agent in managing cardiovascular conditions, offering both efficacy and safety in heart rate management.
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