Which is safer amlodipine or lisinopril
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Safety Comparison of Amlodipine and Lisinopril
Introduction
Amlodipine and lisinopril are commonly prescribed medications for hypertension. Amlodipine is a calcium channel blocker, while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. This article synthesizes research findings to compare the safety profiles of these two drugs.
Adverse Events and Tolerability
Both amlodipine and lisinopril are generally well-tolerated, but they have different side effect profiles. A study comparing the combination of amlodipine plus valsartan with lisinopril plus hydrochlorothiazide found that both regimens were well tolerated, with adverse events being mild to moderate in severity and mostly unrelated to the study drugs. Another study indicated that lisinopril was associated with higher rates of gastrointestinal bleeding and angioedema compared to amlodipine.
Cardiovascular Outcomes
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) provided extensive data on the long-term safety and efficacy of these drugs. The study found no significant differences in primary outcomes such as fatal coronary heart disease or nonfatal myocardial infarction between amlodipine and lisinopril. However, lisinopril was associated with higher rates of stroke, particularly in black patients and women, and higher rates of combined cardiovascular disease (CVD).
Blood Pressure Control
Amlodipine has been shown to provide more consistent blood pressure control over a 24-hour period compared to lisinopril. A study found that amlodipine reduced both systolic and diastolic blood pressure more effectively than lisinopril. Another study confirmed that both drugs were effective in reducing blood pressure, but amlodipine had a more pronounced effect.
Metabolic Effects
In patients with metabolic syndrome, lisinopril was found to have a more favorable metabolic profile compared to amlodipine. The incidence of newly diagnosed diabetes was lower in patients treated with lisinopril compared to those treated with amlodipine. This suggests that lisinopril may be a better option for patients at risk of developing diabetes.
Organ Protection
Both amlodipine and lisinopril have been shown to offer organ protection. A study on the combination of lisinopril and amlodipine found high levels of efficacy and safety, with significant reductions in blood pressure and improvements in organ protection markers such as proteinuria and microalbuminuria. Another study indicated that both drugs were effective in reducing left ventricular mass and improving diastolic function in elderly patients with hypertension.
Conclusion
Both amlodipine and lisinopril are effective and generally well-tolerated options for treating hypertension. Amlodipine may offer better blood pressure control and fewer incidences of stroke and gastrointestinal bleeding, while lisinopril may be more favorable for patients with metabolic syndrome and those at risk of developing diabetes. The choice between these medications should be individualized based on the patient's overall health profile and specific risk factors.
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