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Improving vascular function in hypertension: potential benefits of combination therapy with amlodipine and renin–angiotensin–aldosterone system blockers

Siragy, Helmy M

doi: 10.1097/HJH.0b013e328332bcf0

Hypertension is characterized by endothelial dysfunction and increased risk for adverse cardiovascular outcomes. In addition to lowering blood pressure, the calcium-channel blocker amlodipine and blockers of the renin–angiotensin–aldosterone system (angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers) may further reduce cardiovascular risk by improving endothelial function when used alone or in combination. In fact, the beneficial effects of the combination of amlodipine and a renin–angiotensin–aldosterone system blocker on endothelial function have been found to be greater than the effect of either drug alone, likely due to additive effects on nitric oxide activity. This review summarizes the observed effects of these agents on endothelial function and the complementary mechanisms by which they act, thus providing rationale (beyond blood pressure benefits) for their use in combination.

Department of Medicine, Hypertension Center, University of Virginia, Charlottesville, Virginia, USA

Received 25 March, 2009

Revised 10 August, 2009

Accepted 4 September, 2009

Correspondence to Helmy M. Siragy, MD, Professor of Medicine and Endocrinology, Department of Medicine, Director, Hypertension Center, University of Virginia, Box #801409, Charlottesville, VA 22908, USA Tel: +1 434 924 2961; fax: +1 434 982 3626; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.