Amlodipine beta blocker
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Amlodipine and Beta Blockers: Combined Therapy for Cardiovascular Conditions
Introduction to Amlodipine and Beta Blockers
Amlodipine, a calcium channel blocker, and beta blockers are commonly used medications for managing cardiovascular conditions such as hypertension and angina. While beta blockers are effective in reducing heart rate and blood pressure, amlodipine helps by dilating blood vessels. This article explores the combined use of these medications and their effects on various cardiovascular outcomes.
Anti-Ischaemic Effects in Coronary Patients
Amlodipine and Beta Blockers in Myocardial Ischaemia
In patients with severe coronary conditions experiencing transient myocardial ischaemia despite beta-blocker therapy, the addition of amlodipine was studied. The results indicated that amlodipine did not significantly reduce the frequency or duration of ambulatory ischaemia compared to placebo. However, there was a trend towards decreased exercise-induced ST segment depression and increased ischaemia-free workload capacity.
Long-Term Efficacy in Stable Angina Pectoris
A study involving patients with stable angina pectoris pre-treated with beta blockers showed that chronic treatment with amlodipine significantly decreased ST segment depression and increased ischaemia-free workload capacity. The number of anginal attacks was also reduced, demonstrating the additional anti-ischaemic and anti-anginal efficacy of amlodipine when combined with beta blockers.
Hypertension Management
Blood Pressure Control and Vascular Effects
Combining amlodipine with beta blockers has shown to be effective in managing hypertension. A study comparing the effects of amlodipine and atenolol on small arteries found that amlodipine improved resistance artery structure and endothelial function, whereas atenolol did not. Another study demonstrated that adding amlodipine to atenolol significantly reduced blood pressure in patients whose hypertension was not controlled by atenolol alone.
Central Systolic and Pulse Pressure Reduction
Beta blockers are less effective in reducing central systolic and pulse pressure due to increased aortic augmentation. However, combining amlodipine with beta blockers eliminates this adverse effect, leading to effective reduction of central systolic blood pressure and pulse pressure.
Cardiovascular Outcomes and Stroke Risk
Comparative Cardiovascular Event Prevention
The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA) compared an amlodipine-based regimen with an atenolol-based regimen. The amlodipine-based regimen was more effective in preventing major cardiovascular events, including stroke, and induced less diabetes compared to the atenolol-based regimen. The study also found that amlodipine reduced blood pressure variability, which partly explained the lower risk of stroke.
Quality of Life and Autonomic Nervous Activity
Health-Related Quality of Life
In patients with poorly controlled hypertension, the combination of amlodipine and the beta blocker betaxolol improved cardiac autonomic nervous activity and health-related quality of life more effectively than increasing the dose of amlodipine alone.
Conclusion
The combination of amlodipine and beta blockers offers several benefits in managing cardiovascular conditions, including improved anti-ischaemic effects, better blood pressure control, reduced central systolic and pulse pressure, and enhanced quality of life. These findings support the use of combined therapy for patients who do not achieve optimal outcomes with beta blockers alone.
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