Moderate
Amlodipine × Bisoprolol
Calcium channel blockers (dihydropyridines)×Selective beta-adrenergic blockers
Mechanism
Dihydropyridine calcium channel blocker (amlodipine) + cardioselective beta-blocker (bisoprolol) – additive bradycardia and hypotension. In reduced ejection fraction (below 40%), heart failure decompensation risk.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
The combination is a standard hypertension and angina treatment. In heart failure with reduced ejection fraction, cap amlodipine at 5 mg/day. Check pulse and blood pressure at 1–2 weeks.
Sources
- ESC: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– Eur Heart J 2021;42(36):3599–3726