Beyond Amlodipine-The Case for S-amlodipine as the First Choice Calcium Channel Blocker: An Expert Opinion from India.

Background: Calcium channel blockers (CCBs) have been recommended as the first-line treatment option for the management of hypertension. Amlodipine has been used to treat hypertension over the past 3 decades. However, the chief limitation of amlodipine is pedal edema; it is associated with poor adherence to therapy. Amlodipine is a racemic mixture of two stereoisomers [R(+), S(-)]. Only the S(-) isomer exerts vasodilating action. The R-amlodipine isomer is considered to cause adverse effects.

Aim: To understand the place of S-amlodipine and its combinations in the management of hypertension and related cardiovascular (CV) disorders in the real-world setting in India.

Methodology: A conclave of nine Indian cardiologists was formed to discuss the place of S-amlodipine in the management of hypertension in their clinical practice.

Results: The antihypertensive efficacy of S-amlodipine is comparable to that of amlodipine. S-amlodipine does not cause pedal edema. In fact, switching patients on amlodipine who develop pedal edema to S-amlodipine is helpful in improving patient compliance. However, it would be prudent to initiate treatment with S-amlodipine itself rather than amlodipine, which causes pedal edema. S-amlodipine does not cause gingival hypertrophy, and this improves patient compliance. S-amlodipine consistently lowers blood pressure (BP) across different patient populations such as young, elderly, and patients with CV risk factors.

Conclusion: S-amlodipine has antihypertensive, antianginal actions, and pleiotropic effects. S-amlodipine 2.5 mg is found to be equivalent in its efficacy and tolerability when compared to amlodipine 5 mg in the treatment of mild to moderate hypertension.