Amlodipine + Valsartan

Essential hypertension. Per ESC 2024, ESH 2023 and SEH-LELHA 2022, most patients with confirmed hypertension (BP ≥140/90) start treatment with two drugs in a single pill, and a RAS blocker with a dihydropyridine CCB is one of the two preferred pairs (the other is a RAS blocker with a diuretic). ESC 2024 keeps monotherapy for patients aged 85 and over, with moderate or severe frailty, symptomatic orthostatic hypotension, or elevated BP of 120–139/70–89. The Spanish label indicates the combination for adults whose BP is uncontrolled on amlodipine or valsartan monotherapy and advises titrating the components first, but allows a direct switch from monotherapy. Dose (amlodipine/valsartan): 5/80, 5/160 or 10/160 mg once daily. Full effect at 2–4 weeks. Per the label, peripheral edema is overall less frequent on the combination than on amlodipine monotherapy (5.1% on average across doses), but at 10/160 the difference from amlodipine 10 mg is small: 9.0% vs 10.3%. Contraindicated in the second and third trimesters of pregnancy and not recommended in the first: patients planning pregnancy switch to another drug; not recommended during breastfeeding. Dual RAS blockade with an ACE inhibitor or aliskiren is not recommended, and the combination with aliskiren is contraindicated in patients with diabetes or eGFR <60 mL/min. Monitor potassium and creatinine in chronic kidney disease and with potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes. Anti-inflammatory painkillers (NSAIDs such as ibuprofen) blunt the effect and strain the kidneys. Lithium is not recommended with this drug, and if it cannot be avoided, lithium levels need close monitoring. CYP3A4 inhibitors raise amlodipine exposure, simvastatin no more than 20 mg daily. Contraindicated in severe hepatic impairment, biliary cirrhosis and cholestasis, severe hypotension and shock, severe aortic stenosis and obstructive hypertrophic cardiomyopathy, and in hemodynamically unstable heart failure after myocardial infarction.

ICD-10: I10 · ICD-11: BA00