Amlodipine dosing time and blood pressure control
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Amlodipine Dosing Time and 24-Hour Blood Pressure Control
Once-Daily Amlodipine: Consistent 24-Hour Blood Pressure Reduction
Multiple studies confirm that once-daily dosing of amlodipine, whether in the morning or evening, provides effective 24-hour blood pressure (BP) control in patients with mild to moderate hypertension. These studies show significant reductions in both daytime and nighttime BP, with sustained effects throughout the dosing interval and no significant impact on heart rate or circadian BP patterns 678910.
Morning vs. Evening Dosing: Impact on Nighttime Blood Pressure and Dipper Status
Meta-analyses and randomized trials indicate that while the overall 24-hour and office BP control is similar between morning and evening dosing, taking amlodipine in the evening offers additional benefits. Evening dosing leads to a greater reduction in nighttime BP, a more pronounced decrease in the morning BP surge, and a higher rate of conversion from non-dipper to dipper BP patterns, which is considered beneficial for cardiovascular risk reduction 125. These effects are especially notable in patients with non-dipper hypertension, who do not experience the normal nighttime BP drop 128.
Fixed-Combination Therapies: Enhanced Effect with Bedtime Dosing
For patients using fixed combinations of amlodipine with other antihypertensive agents (such as diuretics or valsartan), bedtime administration further optimizes BP control. Studies show that bedtime dosing of these combinations results in lower nocturnal and 24-hour mean BP, a greater reduction in the morning BP surge, and a higher proportion of patients achieving a normal dipper BP pattern compared to morning dosing 15.
Divided Dosing vs. Once-Daily Dosing: No Additional Benefit
Research comparing once-daily dosing to divided (twice-daily) dosing of amlodipine finds no significant difference in 24-hour BP control, trough plasma drug concentrations, or arterial stiffness. This suggests that splitting the daily dose does not provide extra benefit over a single daily dose for BP management 34.
Conclusion
Amlodipine is effective for 24-hour BP control with once-daily dosing. While both morning and evening dosing are effective, evening or bedtime administration—especially in combination therapies—offers superior nighttime BP reduction and helps restore a healthy dipper BP pattern, which may lower cardiovascular risk. Dividing the daily dose does not improve BP control compared to once-daily dosing.
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