Amlodipine/benazepril: fixed dose combination therapy for hypertension

Abstract

Myocardial infarction, stroke, heart failure and end-stage renal disease have all been linked to inadequate control of blood pressure. Despite overwhelming evidence that uncontrolled hypertension is responsible for a sizeable number of adverse health-related outcomes, control of the disease remains considerably suboptimal. Available data demonstrate that in order to achieve adequate blood pressure control, a large number of patients require therapy with more than one medication. Fixed dose combination antihypertensive therapy has many advantages over other treatment options. Positive effects on blood pressure control, rates of adherence, adverse effects and cost have been identified. Amlodipine/benazepril (Lotrel), Novartis) is a fixed dose combination product indicated for the treatment of hypertension. Although not currently recommended as first-line therapy, studies confirm that this combination of a long-acting calcium antagonist and an angiotensin-converting enzyme (ACE) inhibitor possesses substantial blood pressure lowering capabilities. Whereas adverse events tend to become more frequent with increasing doses of antihypertensive monotherapy, the rate of adverse events attributed to amlodipine/benazepril in clinical trials often correlates with rates ascribed to placebo. Amlodipine/benazepril is capable of sustaining blood pressure control over a 24 h period and appears to be minimally affected by an occasional dose omission. Unlike the older calcium antagonists, amlodipine is unlikely to cause alterations in myocardial contractility. Additionally, the amlodipine/benazepril combination product costs less than the same therapy administered as the individual components. It is, therefore, reasonable to consider therapy with amlodipine/benazepril in appropriate patients after an adequate trial of antihypertensive monotherapy.

Clinical and economic outcomes associated with amlodipine/renin–angiotensin system blocker combinations

“…All antihypertensive agents in general, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), β blockers, calcium channel blockers (CCBs), and thiazide-type diuretics reduce complications of hypertension [Neal et al 2000]; however, the majority of patients require combination therapy to achieve targeted BP goals and reduction in cardiovascular (CV) risk [Black et al 2001;Cushman et al 2002]. Combining agents from diverse, yet complimentary, classes provides a mechanism to target the disease through multiple physiologic actions [Faulkner and Hilleman, 2001;Sica, 2002]. According to JNC 7 guidelines, BP in excess of 20/10 mmHg of goal should be initially treated with two drugs, separately or with fixed-dose combinations (FDCs).…”

Comparative Effectiveness Analysis of Amlodipine/Renin‐Angiotensin System Blocker Combinations

“…About two thirds of the diagnosed hypertensive population will require combination therapy in order to achieve BP goals 6–8 . Therapy using multiple antihypertensive agents from different therapeutic classes treats the disease through multiple physiologic pathways 7,9 . JNC 7 guidelines recommend initial combination therapy for patients presenting with systolic BP (SBP) >20 mm Hg above goal or diastolic BP (DBP) >10 mm Hg above goal, since combination therapy increases the probability of achieving BP goals within a shorter period than single‐drug therapy 4 …”

A Review of the Efficacy of Fixed-Dose Combinations Olmesartan Medoxomil/Hydrochlorothiazide and Amlodipine Besylate/Benazepril in Factorial Design Studies

“…nifedipine/atenolol), β-blocker/thiazide diuretic Most patients will require more than one agent for adequate (e.g. bisoprolol/HCTZ, metoprolol/HCTZ, nadolol/bendroflumecontrol of hypertension, [1,[4][5][6] with the average number needed thiazide, and atenolol/chlortalidone), and ARB/thiazide diuretic being two to four. [7] Given that BP control is not achieved in the (e.g.…”