Amlodipine

Onset of action (antihypertensive): 30-50 minutes

Duration of action: 24 hours

Half-life: 30-50 hours

Cost: amlodipine besylate $0.80 per day / norvasc $2.27-3.01 per day

ASCOT-BPLA: 19,257 HTN pts, 40-79y, 3 CV risk factors randomized to amlodipine (5-10mg) + ACEi vs atenolol+thiazide, follow-up 5.5 years. Average BP drop 164.0/97.7 to 136.9/78.3, change of 26.6/16.6. (1) All-cause mortality ARR 1.6%, NNT 62.5, (2) CV mortality ARR 1.6%, NNT 62.5, (3) stroke ARR 1.9%, NNT 52.6. (re: Lancet 2005 Sep; 366(9489): 895).

VALUE: 15,047 HTN pts, randomized to Valsartan or Amlodipine. At 1 month, SBP in the amlodipine group was 4.0 mm Hg lower than the valsartan group. At 6m, 2.1 mm Hg lower. At 1m, 23% in Amlodipine group had SBP > 160, in Valsartan group 32.6%. At 6m, 8.3% vs 13.2%. Cardiovascular events the same in both groups. (re: value - Lancet 2004.pdf  

ACCOMPLISH: 11,506 HTN pts (age 68.4, 60% male, 84% white) with high CV risk randomized to benazepril+amlodipine vs benazepril+HCTZ. Mean BP in B+A was 131.6/73.3 vs B+H 132.5/74.4.  Average change was B+A 13.7/6.8 vs B+H 12.9/5.6. CV death ARR 0.4%, NNT 250. MI ARR 0.6, NNT 167. Stroke ARR 0.4%, NNT 250. Coronary revascularization ARR 0.9%, NNT 111. All cause death ARR 0.4%, NNT 250. Hospitalization for CHF, no change. (re: NEJM 4 Dec 2008; 359: 2437)

ALLHAT:

PRAISE: (re: NEJM 1996; 335(15): 1107)

PRAISE 2: