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Uptitration of the original drug to double the dosage is reasonable only if distinctly enhanced antihypertensive efficacy has been documented and the cost is not prohibitive. Most antihypertensive drugs have a rather shallow dose-response curve and increasing the dose has little additional effect on BP. For instance, doubling the starting dose oflosartan from 50 mg to 100 mg, has not been shown to increase antihypertensive efficacy. In a situation like this, it is more rational to combine a low dose of a diuretic with the ARB. Indeed, the combination has been shown to lower BP better than a higher dose of losartan monotherapy [29].

In contrast, additional antihypertensive efficacy can be gained using amlodipine when the starting dose is doubled from 5 mg to 10 mg; furthermore, the cost of the 10 mg dose is less than that of two 5 mg doses. However, the incidence of pedal edema also increases with the higher dose of amlodipine. Pedal edema is a well-known, dose-dependent side effect ofall dihydropyridine calcium antagonists (Figure 8) [23,30]. In a middle-aged, overweight woman, it is probably not a good idea to uptitrate to 10 mg of amlodipine because the likelihood of her experiencing pedal edema is substantial.

As can be seen in Figure 8, uptitration from 15 mg to 20 mg does not increase antihypertensive efficacy but doubles the occurrence of pedal edema.

Dose Response Curve Amlodipine
Figure 8 Dose-response curve with a dihydropyridine calcium antagonist. CR, controlled release; SSBP, supine systolic blood pressure. Adapted from Chrysant etal. [30].

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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