The dose is 5 mg initially o doses higher than 10 mg

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The dose is 5 mg initially. o Doses higher than 10 mg have not demonstrated any increase in benefit. Amlodipine has been used in combination with several BBs to produce improved response. Diltiazem, also effective in angina therapy, is less likely to cause hypotension and other adverse responses associated with peripheral vasodilation (reflex tachycardia) than nifedipine. It has less negative inotropic activity than verapamil. o The reduction in average daily heart rate improves coronary artery filling time and myocardial oxygen supply. Diltiazem is a good choice for patients who need to reduce their heart rate. Verapamil is more often prescribed for treatment of arrhythmias because it has the most potent negative inotropic effect and significantly slows AV nodal conduction. It is not used for patients with compromised LV function, bradycardia, or AV block. Verapamil might be chosen for patients with supraventricular tachycardia who also have angina o Vasospastic (Variant, Prinzmetal’s) Angina CCBs that produce more coronary artery vasodilation and reduce vasospasm are the drugs of choice. Diltiazem, long-acting nifedipine, and amlodipine are the most commonly used. o Unstable Angina Medical therapy for unstable angina involves nitrates, BBs, and heparin, which are effective in controlling pain, and aspirin, which reduces mortality. When vasospasm is a component of this angina, CCBs may offer an additional treatment o Verapamil is the CCB of choice. Type 2 CCBs are contraindicated because they tend to increase heart rate and have less vasospastic protection. Because verapamil is often given in combination with other drugs that lower BP, hypotension is a serious potential adverse response o Hypertension Initial drug therapy for HTN is monotherapy. Because ACEIs, ARBs, and diuretics have been shown to reduce cardiovascular morbidity and mortality in controlled trials, all are considered first-line medications in the new “JNC-8” guidelines o BBs are no longer used as first-line treatment for reducing BP. They are used in the post-MI population or added to the plan if the first-line drugs have proved ineffective.
The guidelines indicate black patients as a group are more responsive to diuretics and CCBs than they are to RAAS medications. o CCBs are also indicated for both severe (BP greater than 160/110) and nonsevere hypertension (BP 140 to 159/90 to 109) in pregnancy CCBs would also be appropriate for patients with certain concomitant pathologies (such as unstable asthma) in which BBs are contraindicated. Amlodipine is especially good for HTN patients with LV dysfunction and CHF. Long-acting nifedipine, diltiazem, or verapamil may be used for patients with CAD. Long-acting nifedipine is a good choice as well for patients who also have peripheral-vascular disease (PVD) because of its peripheral vasodilating effect.

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