Amlodipine postural hypotension
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Amlodipine and Postural Hypotension: A Comprehensive Review
Introduction to Amlodipine
Amlodipine is a dihydropyridine calcium channel blocker widely used to treat hypertension and angina pectoris. It works by inhibiting calcium influx in vascular smooth muscle cells, leading to vasodilation and reduced blood pressure 12. Amlodipine is known for its long half-life, making it suitable for once-daily dosing .
Efficacy in Hypertension and Angina
Clinical trials have demonstrated that amlodipine effectively lowers blood pressure in patients with mild to moderate hypertension and alleviates symptoms of angina pectoris 12. It has been shown to be as effective as other antihypertensive agents, including beta-blockers, diuretics, ACE inhibitors, and other calcium channel blockers .
Tolerability and Common Adverse Effects
Amlodipine is generally well tolerated. The most common side effects are related to its vasodilatory action, such as edema, headaches, and flushing 12. Importantly, amlodipine does not typically cause adverse changes in serum lipid patterns, cardiac conduction disturbances, or reflex tachycardia 12.
Amlodipine and Postural Hypotension
Absence of Postural Hypotension
Multiple studies have consistently reported that amlodipine does not cause postural hypotension, a condition characterized by a significant drop in blood pressure upon standing 1235. This is a notable advantage over some other antihypertensive medications, which can lead to this undesirable effect.
Clinical Evidence
In a study involving intra-arterial blood pressure monitoring, amlodipine was shown to maintain blood pressure control throughout the dosing interval without causing postural hypotension . Another clinical report confirmed that patients treated with amlodipine did not experience postural hypotension or reflex tachycardia, further supporting its safety profile in this regard .
Comparative Studies
Comparative studies have also highlighted that amlodipine is at least as well tolerated as other standard antihypertensive agents, with a lower incidence of postural hypotension . This makes it a preferable option for patients who are at risk of this condition.
Case Reports and Special Considerations
While amlodipine is generally safe, there are isolated case reports of severe hypotension in specific scenarios. For instance, an elderly patient experienced postural hypotension after discontinuing amlodipine, which was initially prescribed for hypertension . Additionally, severe hypotension has been reported in patients on amlodipine undergoing spinal anesthesia, although this is not typical and may be influenced by other factors .
Conclusion
Amlodipine is a highly effective and well-tolerated antihypertensive and antianginal agent. Its lack of association with postural hypotension makes it a valuable option for many patients. While isolated cases of severe hypotension have been reported, these are not common and often involve additional complicating factors. Overall, amlodipine remains a reliable choice for managing hypertension and angina without the risk of postural hypotension.
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