Amlodipine orthostatic hypotension

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Amlodipine and Orthostatic Hypotension: A Comprehensive Overview

Introduction to Amlodipine and Orthostatic Hypotension

Amlodipine, a calcium channel blocker, is widely used to manage hypertension. Orthostatic hypotension (OH) is a condition characterized by a significant drop in blood pressure upon standing, which can lead to dizziness, fainting, and falls. Understanding the relationship between amlodipine and OH is crucial, especially for older adults and those with comorbid conditions.

Amlodipine and Risk of Falls in Older Adults

Research indicates that the choice of antihypertensive medication can influence the risk of falls, syncope, and OH in older adults. A study from the ALLHAT trial found that while long-term use of amlodipine did not significantly affect the risk of OH, it did increase the risk of falls within the first year of initiation compared to chlorthalidone and lisinopril . This suggests that while amlodipine is generally safe, caution is needed during the initial treatment period.

Amlodipine and Orthostatic Hypotension in Hypertensive Patients

The AASK trial examined the effects of different antihypertensive medications, including amlodipine, on OH in patients with chronic kidney disease. The study found that amlodipine did not significantly increase the risk of OH compared to other medications like ramipril and metoprolol . This indicates that amlodipine can be a safe option for managing hypertension without exacerbating OH in this patient population.

Clinical Efficacy and Safety of Amlodipine

A comprehensive review of clinical trials has shown that amlodipine effectively controls blood pressure over a 24-hour period without causing significant OH . This makes it a reliable option for long-term hypertension management. Additionally, studies on elderly patients with isolated systolic hypertension have demonstrated that amlodipine significantly reduces systolic blood pressure without causing OH or reflex tachycardia, further supporting its safety profile in older adults .

Perioperative Considerations for Amlodipine

There are concerns about the use of amlodipine in the perioperative period. A case series reported severe hypotension in patients on amlodipine who underwent spinal anesthesia, despite withholding the morning dose of the medication . This suggests that while amlodipine is generally safe, it may pose risks in specific clinical scenarios, such as during surgery.

Conclusion

Amlodipine is an effective antihypertensive agent with a generally favorable safety profile regarding orthostatic hypotension. However, it may increase the risk of falls in the initial treatment phase and cause severe hypotension in perioperative settings. Clinicians should monitor patients closely during these periods to mitigate potential risks.

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Most relevant research papers on this topic

Effects of Antihypertensive Class on Falls, Syncope, and Orthostatic Hypotension in Older Adults.

Amlodipine increases the risk of falls within 1 year of initiation for older adults with hypertension, while chlorthalidone and lisinopril show no significant long-term effects on these risks.

RCTLarge Human TrialRigorous Journal

2019·

23citations

·S. Juraschek et al.

Hypertension Treatment Effects on Orthostatic Hypotension and Its Relationship With Cardiovascular Disease: Results From the AASK Trial

A lower blood pressure goal does not increase the risk of orthostatic hypotension or its consequences, but metoprolol may increase systolic OH.

RCTLarge Human TrialVery Rigorous Journal

2018·

32citations

·S. Juraschek et al.

Amlodipine in hypertension: an overview of the clinical dossier.

Amlodipine is an effective and well-tolerated antihypertensive drug, providing smooth 24-hour blood pressure control without orthostatic hypotension and being well-tolerated as monotherapy or in combination with other drugs.

Systematic Review

1988·

58citations

·Stevo Julius

[Amlodipine in isolated systolic hypertension in the aged].

Amlodipine effectively reduces systolic arterial pressure in elderly patients without causing orthostatic hypotension or reflex tachycardia.

RCT

1993·

3citations

·L. Mariani et al.

Severe hypotension following spinal anesthesia in patients on amlodipine

Spinal anesthesia for orthopedic surgery can cause severe hypotension in patients on amlodipine, even when the drug is withheld.

Case ReportVery Rigorous Journal

2012·

4citations

·S. Parida et al.

Amlodipine

Amlodipine is an effective and well-tolerated alternative to other cardiovascular agents for treating essential hypertension and chronic stable angina pectoris.

Highly Cited

2012·

205citations

·D. Murdoch et al.

A Case of Severe, Refractory Hypotension After Amlodipine Overdose

A severe amlodipine overdose can cause refractory hypotension, even with multiple therapeutic approaches, leading to anoxic brain injury and suspected herniation.

Case Report

2018·

17citations

·Melissa Chudow et al.

Severe intoxication after an intentional overdose of amlodipine

Hyperinsulinaemia-euglycaemia therapy may be considered as a first-line therapy in calcium channel blocker intoxication, as it can raise blood pressure and improve heart block symptoms.

Case Report

2003·

57citations

·Lars Melholt Rasmussen et al.

Hypertension and orthostatic hypotension in older patients.

Lowering blood pressure in older patients reduces stroke, coronary events, and cardiovascular-related mortality, but clinicians must consider orthostatic hypotension and potential fall risks when reducing blood pressure.

Very Rigorous Journal

2012·

18citations

·E. Judd et al.

Management of Orthostatic Hypotension in the Hospitalized Patient. A Narrative Review.

Orthostatic hypotension in hospitalized patients can be managed by removing offending medications, avoiding large meals, and using norepinephrine "enhancers" or "replacers" to improve symptoms and reduce hospital stay.

Systematic Review

2021·

5citations

·Amr Wahba et al.

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