Lisinopril amlodipine
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Comparative Analysis of Lisinopril and Amlodipine in Hypertension Management
Introduction to Lisinopril and Amlodipine
Lisinopril and amlodipine are commonly prescribed medications for managing hypertension. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, while amlodipine is a calcium channel blocker. Both drugs are effective in lowering blood pressure, but they have different mechanisms of action and effects on cardiovascular health.
Blood Pressure Reduction and Efficacy
Monotherapy and Combination Therapy
Both lisinopril and amlodipine effectively reduce blood pressure when used as monotherapy. Studies have shown that combining these two drugs can lead to a more significant reduction in blood pressure compared to either drug alone2 8. This combination therapy is particularly beneficial for patients with stage 2 hypertension, achieving target blood pressure levels in a majority of patients8 9.
Predictors of Response
The response to lisinopril is influenced by baseline plasma renin activity, whereas the response to amlodipine is independent of renin levels and tends to be greater in patients with higher initial blood pressure2. Additionally, Black patients may not respond as well to lisinopril monotherapy compared to Caucasians, although they respond similarly to the combination therapy2.
Cardiovascular Effects
Left Ventricular Mass and Diastolic Function
Both lisinopril and amlodipine have been shown to reduce left ventricular mass and improve diastolic function in elderly hypertensive patients. The ELVERA trial demonstrated that both drugs led to similar reductions in left ventricular mass index (LVMI) and improvements in the early to atrial filling ratio (E/A ratio) over a two-year period1.
Intima-Media Thickness
Lisinopril and amlodipine also reduce intima-media thickness (IMT) in the carotid and femoral arteries, which is a marker of atherosclerosis. The ELVERA trial found no significant differences between the two drugs in their effects on IMT, although amlodipine showed a more pronounced effect on the elastic common carotid artery3 7.
Hemodynamic Effects
Amlodipine increases blood flow and wall shear stress (WSS) in the common carotid artery more than lisinopril, despite similar reductions in blood pressure. This difference in hemodynamic effects could contribute to variations in arterial remodeling observed in long-term studies5.
Renal Function and Microalbuminuria
Lisinopril has a more pronounced effect on reducing urinary albumin excretion compared to amlodipine, which suggests a protective effect on renal function. This effect is likely due to changes in intrarenal hemodynamics or glomerular permeability6. Both drugs, however, effectively lower blood pressure and are well-tolerated by patients6 9.
Conclusion
Lisinopril and amlodipine are both effective antihypertensive agents with distinct mechanisms of action. While both drugs reduce blood pressure and have beneficial effects on cardiovascular health, their combination offers enhanced efficacy. Lisinopril may offer additional renal protection by reducing microalbuminuria, whereas amlodipine may provide superior hemodynamic benefits in certain vascular regions. The choice between these medications should be tailored to individual patient profiles and specific clinical needs.
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Most relevant research papers on this topic
Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial
Both amlodipine and lisinopril reduce left ventricular mass and improve diastolic function similarly in elderly, newly diagnosed hypertensive patients.
RCT
Highly CitedAmlodipine and lisinopril in combination for the treatment of essential hypertension: efficacy and predictors of response
Amlodipine and lisinopril in combination significantly lower blood pressure, with Black patients showing less response to lisinopril monotherapy but similar response to the combination.
RCTEffects of amlodipine and lisinopril on intima–media thickness in previously untreated, elderly hypertensive patients (the ELVERA trial)
Amlodipine and lisinopril both reduce intima-media thickness similarly in elderly hypertensive patients, with amlodipine showing a slightly better effect on elastic carotid arteries.
RCTHighly CitedHemodynamic effects of amlodipine, bisoprolol, and lisinopril in hypertensive patients after liver transplantation1
Lisinopril is the preferred treatment for hypertension after liver transplantation, as it reduces augmentation index and systolic blood pressure more effectively than bisoprolol.
RCTCarotid artery hemodynamics: observing patient-specific changes with amlodipine and lisinopril by using MR imaging computation fluid dynamics.
Amlodipine increases blood flow and decreases wall shear stress in the common carotid artery compared to lisinopril, potentially contributing to differences in long-term carotid artery remodeling.
RCTEffects of lisinopril and amlodipine on microalbuminuria and renal function in patients with hypertension
Lisinopril reduces urinary albumin excretion in patients with essential hypertension, potentially due to modifications in intrarenal hemodynamics or changes in glomerular permeability.
RCTEffects of blood pressure lowering with amlodipine or lisinopril on vascular structure of the common carotid artery.
A decrease in blood pressure leads to regression of structural changes in the carotid artery, with amlodipine showing greater regression of intima-media thickness than lisinopril.
RCTTolerability and blood pressure-lowering efficacy of the combination of amlodipine plus valsartan compared with lisinopril plus hydrochlorothiazide in adult patients with stage 2 hypertension.
The combination of amlodipine plus valsartan is more tolerable and effective in lowering blood pressure than lisinopril plus hydrochlorothiazide in patients with stage 2 hypertension.
RCTHighly Cited[LB.01.07] ALLIANCE STUDY: EVALUATION OF THE EFFICIENCY FOR IMPLEMENTATION FIXED ANTIHYPERTENSIVE DRUG COMBINATION OF LISINOPRIL/AMLODIPINE IN PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION
Fixed combination lisinopril + amlodipine effectively reduces blood pressure and cholesterol levels in patients with essential arterial hypertension, with no serious adverse events observed.
Non-RCT
Large Human Trial
Very Rigorous JournalEffect of amlodipine, lisinopril and allopurinol on acetaminophen-induced hepatotoxicity in rats
Amlodipine, lisinopril, and allopurinol can protect against acetaminophen-induced hepatotoxicity, with calcium channels, angiotensin converting enzyme, and xanthine oxidase playing roles in the injury.
RCT
Animal Study