Amlodipine vs ace inhibitors
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Blood Pressure Reduction: Amlodipine vs ACE Inhibitors in Hypertension
Multiple studies have compared the effectiveness of amlodipine, a calcium channel blocker, with ACE inhibitors for lowering blood pressure in adults, especially the elderly. Research consistently shows that amlodipine leads to a greater reduction in systolic blood pressure (SBP) compared to ACE inhibitors. In elderly patients (over 60 years), amlodipine reduced SBP by about 26.7 mmHg, which was significantly more than the 15.8 mmHg reduction seen with ACE inhibitors. The difference in diastolic blood pressure (DBP) reduction was smaller and not statistically significant between the two groups. These findings suggest that amlodipine may be a better option for managing systolic hypertension in older adults 125.
Achievement of Target Blood Pressure and Efficacy
Amlodipine not only lowers blood pressure more effectively but also helps more patients reach their target blood pressure compared to ACE inhibitors. Patients treated with amlodipine were about four times more likely to move to a better blood pressure stage than those treated with ACE inhibitors, even after adjusting for age, sex, and disease severity 25.
Safety and Side Effect Profiles: Amlodipine vs ACE Inhibitors
While both drug classes are effective, their side effect profiles differ. ACE inhibitors are more likely to cause cough and renal issues, while amlodipine is more often associated with peripheral edema. Rarely, amlodipine can also cause angioedema, both alone and in combination with certain ACE inhibitors, so monitoring for this side effect is important, especially when starting therapy 59.
Combination Therapy: Amlodipine and ACE Inhibitors
Combining amlodipine with an ACE inhibitor can provide additional benefits, especially in patients with heart failure. This combination improves vascular resistance and neurohormonal activity more than either drug alone. There is also a synergistic effect on nitric oxide production in the blood vessels, which may contribute to the positive effects of this combination in heart disease and heart failure 467.
Medication Adherence: Fixed-Dose Combinations
Adherence to antihypertensive therapy is crucial for blood pressure control. Studies show that patients are more likely to stick to their medication when taking a fixed-dose combination of amlodipine and an ACE inhibitor (such as benazepril) compared to taking the two drugs separately. This improved adherence is seen regardless of how many other medications the patient is taking, and it can also help reduce overall treatment costs 38.
Monitoring and Real-World Adherence
Therapeutic drug monitoring can help identify non-adherence to both amlodipine and ACE inhibitors. Non-adherence is strongly linked to poor blood pressure control, highlighting the importance of regular monitoring and patient education to improve outcomes .
Conclusion
Amlodipine generally provides greater systolic blood pressure reduction and a higher rate of achieving target blood pressure compared to ACE inhibitors, especially in older adults. While both drug classes have distinct side effect profiles, amlodipine is associated with more peripheral edema, and ACE inhibitors with cough and renal issues. Combination therapy and fixed-dose combinations can enhance both efficacy and adherence. Ultimately, the choice between amlodipine and ACE inhibitors should be individualized, considering both effectiveness and potential side effects.
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