Does amlodipine affect heart rate
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The Impact of Amlodipine on Heart Rate: A Comprehensive Review
Introduction to Amlodipine and Heart Rate
Amlodipine, a calcium channel blocker, is widely used to treat hypertension and angina. Its effects on heart rate (HR) have been a subject of various studies, aiming to understand its influence on cardiovascular health. This article synthesizes findings from multiple research papers to provide a clear picture of how amlodipine affects heart rate.
Amlodipine and Heart Rate Variability
Influence on Heart Rate Variability (HRV)
Research indicates that amlodipine does not significantly alter heart rate variability (HRV) parameters in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction. However, it does reduce the influence of the sympathetic autonomic nervous system, shifting the autonomic balance towards increased vagal activity .
Circadian Effects on Heart Rate
Morning vs. Evening Dosing
A study comparing the effects of morning and evening dosing of amlodipine on circadian blood pressure and heart rate found no significant differences in heart rate between the two dosing times. However, the study highlighted that morning dosing had a better effect on circadian blood pressure .
Sympathetic Nerve Activity and Heart Rate
Comparison with Nifedipine
Amlodipine has been shown to decrease plasma and urinary norepinephrine levels, indicating a reduction in sympathetic nerve activity. This contrasts with short-acting nifedipine, which increases these levels. Amlodipine also reduces the low-frequency to high-frequency ratio, suggesting a decrease in sympathetic activity and a potential beneficial effect on heart rate over the long term .
Hemodynamic Effects
Acute and Chronic Administration
In patients with stable angina, intravenous administration of amlodipine resulted in a slight increase in heart rate from 75 to 80 beats per minute. This increase was accompanied by a decrease in systemic vascular resistance and mean arterial pressure, without significant changes in cardiac output or other hemodynamic parameters .
Animal Studies on Heart Rate
Telemetric Monitoring in Rats
In telemetric studies on rats, amlodipine caused a dose-dependent increase in heart rate, with more pronounced effects during the light span compared to the dark span. This suggests a circadian phase-dependency in the cardiovascular effects of amlodipine .
Cardioprotective Effects
Ischemic-Reperfused Heart
In studies on ischemic-reperfused myocardium, amlodipine did not significantly affect heart rate but showed cardioprotective effects by improving myocardial function and blood flow during reperfusion. This indicates that while amlodipine may not directly alter heart rate, it can enhance overall cardiovascular health Dunlap1989Rämö1989.
Clinical Implications
Chronic Stable Angina
In patients with chronic stable angina, amlodipine significantly reduced both symptomatic and asymptomatic ischemic events over 24 hours, maintaining the intrinsic circadian pattern of heart rate. This suggests that amlodipine can effectively manage ischemia without adversely affecting heart rate .
Conclusion
Amlodipine has a nuanced effect on heart rate, primarily characterized by a reduction in sympathetic nerve activity and a slight increase in heart rate under certain conditions. Its overall impact on cardiovascular health is positive, with significant benefits in reducing ischemic events and improving myocardial function. These findings underscore the importance of considering both the direct and indirect effects of amlodipine on heart rate in clinical practice.
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