Amlodipine + Olmesartan

Essential hypertension in adults. Per ESC 2024 (Class I), ESH 2023 and the Spanish SEH-LELHA 2022 guideline, most patients with confirmed hypertension start treatment with two drugs in a single pill; a renin-angiotensin-aldosterone system blocker (RAAS blocker, here olmesartan) with a dihydropyridine calcium channel blocker (here amlodipine) is one of the two preferred starting pairs. Monotherapy is reserved for specific groups (very old or frail patients, orthostatic hypotension and, per ESH 2023, low-risk grade 1 hypertension). The Spanish SmPC (AEMPS) indicates the combination for adults whose blood pressure is not controlled on olmesartan or amlodipine monotherapy and allows a direct switch from monotherapy when clinically appropriate. ESC 2024 target: systolic BP 120–129 mmHg if well tolerated. In Spain the tablets are 20/5, 40/5 and 40/10 mg (olmesartan/amlodipine) once daily with or without food; the maximum effect is reached within the first 2 weeks. With creatinine clearance 20–60 mL/min and in moderate hepatic impairment olmesartan is capped at 20 mg/day; with clearance <20 mL/min the combination is not recommended. Contraindicated in the second and third trimesters of pregnancy (not recommended in the first), in severe hepatic impairment and biliary obstruction, severe hypotension, shock, severe aortic stenosis, unstable heart failure after acute myocardial infarction, and with aliskiren in diabetes or eGFR <60 mL/min/1.73 m²; not recommended during breastfeeding. Potassium and creatinine are monitored, especially in chronic kidney disease, heart failure and with potassium supplements or potassium-sparing diuretics; combination with lithium and dual RAAS blockade are not recommended. Olmesartan carries a risk of its own: very rare sprue-like enteropathy (SmPC warning, FDA 2013), severe chronic diarrhoea with weight loss after months or years of use; olmesartan is stopped and not restarted.

ICD-10: I10 · ICD-11: BA00