Mitigation of calcium channel blocker-related oedema in hypertension by antagonists of the renin-angiotensin system

J Hum Hypertens. 2009 Aug;23(8):503-11. doi: 10.1038/jhh.2008.157. Epub 2009 Jan 15.

Abstract

This review is aimed at examining calcium channel blocker (CCB)-related oedema and how this can be attenuated through the use of agents that inhibit the renin-angiotensin system. CCBs are effective antihypertensive agents, but their propensity for causing oedema may reduce compliance. A review of the literature has indicated that the absolute incidence of this side effect is difficult to determine because reported rates vary widely, a factor that may stem from differences in the surveillance technique (active vs passive). In a recent trial incorporating active surveillance, 25% of patients who received amlodipine 10 mg per day experienced oedema. CCB-induced oedema is caused by increased capillary hydrostatic pressure that results from preferential dilation of pre-capillary vessels. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) cause post-capillary dilation and normalize hydrostatic pressure, and are thus ideally suited for prevention/reversal of CCB-induced oedema. The efficacy of this strategy was proven using both subjective and objective techniques. ARB/CCB and ACEI/CCB combination therapy is also more effective than CCB monotherapy in controlling blood pressure. These combinations represent an important advance in the management of hypertension.

Publication types

  • Review

MeSH terms

  • Amlodipine / administration & dosage
  • Amlodipine / adverse effects
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / adverse effects*
  • Calcium Channel Blockers / administration & dosage
  • Calcium Channel Blockers / adverse effects*
  • Clinical Trials as Topic
  • Drug Therapy, Combination
  • Edema / chemically induced*
  • Edema / prevention & control*
  • Humans
  • Hypertension / drug therapy*
  • Medication Adherence
  • Treatment Outcome

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Amlodipine