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Amlodipine versus Angiotensin-receptor blockers for nonhypertension indications
James S Kalus1, C Michael White
1Hartford Hospital/University of Connecticut, Hartford, CT, USA.
Insights
Amlodipine and angiotensin-receptor blockers (ARBs) effectively lower blood pressure. ARBs offer benefits for heart failure and kidney protection, while amlodipine excels in treating angina.
Area of Science:
- Cardiovascular Pharmacology
- Nephrology
Background:
- Amlodipine and Angiotensin-Receptor Blockers (ARBs) are widely used antihypertensive agents.
- Understanding their comparative efficacy and safety is crucial for clinical decision-making.
Purpose of the Study:
- To review the efficacy and safety of amlodipine and ARBs.
- Focus on specific conditions: heart failure, angina, percutaneous coronary intervention (PCI), and renal protection.
Main Methods:
- Comprehensive MEDLINE search from 1966 to December 2001.
- Keywords included amlodipine and various ARBs (losartan, valsartan, candesartan, telmisartan).
- Inclusion of English-language articles representative of the review's scope.
Main Results:
- Both amlodipine and ARBs demonstrate similar blood pressure-lowering effects.
- Amlodipine is effective for angina; ARBs are not.
- ARBs show efficacy in heart failure, renal protection, and preventing restenosis post-PCI.
- ARBs are beneficial in preventing diabetic and non-diabetic nephropathy.
Conclusions:
- Treatment choice between amlodipine and ARBs should consider patient's concomitant disease states.
- ARBs offer advantages in heart failure and renal protection compared to amlodipine.
Objective:
To review the efficacy and safety data of amlodipine and the angiotensin-receptor blockers (ARBs), focusing on heart failure, angina, percutaneous coronary intervention (PCI), and renal protection.
Data Source:
A MEDLINE search (1966-December 2001) was completed using amlodipine, angiotensin-receptor antagonist, losartan, valsartan, candesartan, and telmisartan as key words. English-language articles were identified and included.
Study Selection And Data Extraction:
All identified articles were evaluated. Articles representative of the subject matter of our review were included.
Data Synthesis:
Amlodipine and the ARBs lower blood pressure to a similar extent. Amlodipine is an effective antianginal agent, whereas ARBs are not. However, amlodipine is not effective in the treatment of heart failure; ARBs may be useful in this setting. ARBs are also effective in preserving renal function and may provide some protection from restenosis in patients who have had a PCI. The ARBs may also be useful in preventing both diabetic and nondiabetic nephropathy.
Conclusions:
Concomitant disease states should be considered when choosing between an ARB and amlodipine for the management of hypertension.