Blood pressure tablets that don't cause ankle swelling
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Blood Pressure Tablets That Don't Cause Ankle Swelling
Managing hypertension effectively often involves the use of medications, but some of these can cause undesirable side effects such as ankle swelling. This article explores various blood pressure medications and their propensity to cause or avoid this particular side effect.
Calcium Channel Blockers and Ankle Swelling
Felodipine and Ankle Swelling
Felodipine, a calcium channel blocker (CCB), is effective in reducing blood pressure but is associated with vasodilatory side effects, including ankle swelling. A study comparing extended-release (ER) and plain tablets of felodipine found that both formulations significantly reduced blood pressure. However, ankle swelling was a common adverse event, leading to the withdrawal of some patients from the study1.
Nifedipine and Local Vasodilation
Nifedipine, another CCB, has been shown to cause ankle swelling due to its vasodilatory effects. Research indicates that nifedipine increases foot volume, supporting the hypothesis that ankle edema is a local phenomenon at the site of vasodilation. This side effect was not observed with other drugs like diazoxide, suggesting a unique mechanism of edema formation with nifedipine2. Additionally, a study on nifedipine tablets for systemic hypertension reported mild ankle edema in some patients, further confirming this side effect4.
Combination Therapy to Mitigate Ankle Swelling
Manidipine and Delapril Combination
Combining an angiotensin-converting enzyme inhibitor (ACEI) with a CCB can be a strategic approach to reduce the incidence of ankle edema. A study evaluated the effect of adding the ACEI delapril to the CCB manidipine in patients with mild to moderate hypertension. The combination therapy resulted in better blood pressure control and significantly reduced the incidence of ankle edema compared to manidipine monotherapy. This suggests that the addition of delapril can counteract the microcirculatory changes induced by manidipine, thereby reducing ankle swelling3.
Conclusion
While calcium channel blockers like felodipine and nifedipine are effective in managing hypertension, they are often associated with ankle swelling due to their vasodilatory effects. However, combining these medications with ACE inhibitors, such as delapril, can mitigate this side effect, offering a more tolerable treatment option for patients. This combination therapy approach provides better blood pressure control with a lower incidence of adverse effects, making it a viable option for those prone to developing ankle edema.
Sources and full results
Most relevant research papers on this topic
Felodipine extended-release tablets once daily are equivalent to plain tablets twice daily in treating hypertension. Dutch Hospital Multicentre Group.
Felodipine extended-release tablets once daily are as effective and tolerable as plain tablets twice daily in treating hypertension.
RCTOedema formation with the vasodilators nifedipine and diazoxide: direct local effect or sodium retention?
Nifedipine administration causes ankle oedema as a local phenomenon at the site of vasodilation, while diazoxide administration may indicate a different mechanism of oedema formation.
RCTEffect on the development of ankle edema of adding delapril to manidipine in patients with mild to moderate essential hypertension: a three-way crossover study.
Adding delapril to manidipine effectively reduces blood pressure and ankle edema development in patients with mild to moderate essential hypertension.
RCTNifedipine tablets for systemic hypertension: a study using continuous ambulatory intraarterial recording.
Nifedipine tablets effectively lower blood pressure consistently over 24 hours in ambulant patients and during exercise testing, suggesting potential as initial therapy for systemic hypertension.
Non-RCT
Highly CitedValsartan/amlodipine single pill combination for the treatment of hypertension
The single pill combination of valsartan and amlodipine effectively lowers blood pressure and is a tolerable treatment option for patients needing combination treatment for hypertension.
Dihydropyridine calcium channel blockers and peripheral side effects
Nifedipine can cause peripheral side effects, such as ankle swelling and rash, and discontinuing the drug can resolve these issues.
Case ReportCasein hydrolysate containing Val-Pro-Pro and Ile-Pro-Pro improves central blood pressure and arterial stiffness in hypertensive subjects: a randomized, double-blind, placebo-controlled trial.
Casein hydrolysate containing Val-Pro-Pro and Ile-Pro-Pro improves central blood pressure and arterial stiffness in hypertensive subjects, suggesting potential beneficial effects on arterial properties.
RCTIbuprofen in the treatment of acute ankle joint injuries
Ibuprofen does not reduce ankle swelling or pain in acute ankle joint injuries, and ice-sprays, icebags, or cold water do not influence swelling reduction during treatment.
RCTEffects of Beraprost Sodium (Dorner®) in Patients with Diabetes Mellitus Complicated by Chronic Arterial Obstruction
Beraprost sodium improves ankle pressure index and lower extremity symptoms in diabetic patients with chronic arterial obstruction, suggesting its potential use in treating peripheral circulatory disorders.
Non-RCTDiclofenac Sodium Topical Gel (DSG) 1% Reduces Swelling and Tenderness and Improves Ankle Joint Function in Subjects with Acute Ankle Sprain: A Randomized, Double-Blind, Placebo-Controlled Trial
DSG 1% Topical Gel effectively reduces pain, swelling, and tenderness in acute ankle sprains, improving ankle joint function compared to placebo.
RCT
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