Amlodipine is a medication commonly used to treat high blood pressure, also known as hypertension. It belongs to a class of drugs called calcium channel blockers, which work by relaxing blood vessels so the heart does not have to pump as hard[2]. High blood pressure is a common problem, especially in older adults, and many people with Alzheimer’s disease also have high blood pressure. This raises an important question: Is amlodipine safe for people with Alzheimer’s disease?
To answer this, we need to look at how amlodipine works, how Alzheimer’s disease affects the body, and what research says about using blood pressure medications in people with dementia, including Alzheimer’s.
## How Amlodipine Works
Amlodipine helps lower blood pressure by blocking calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and widen, which lowers blood pressure and makes it easier for the heart to pump blood[2]. It is often prescribed to older adults because it is generally well tolerated and effective[2]. Some studies have shown that fixed-dose combinations of amlodipine with other drugs, like indapamide, are also effective and generally safe in older adults[6].
## Alzheimer’s Disease and Blood Pressure
Alzheimer’s disease is the most common form of dementia. It affects memory, thinking, and behavior. People with Alzheimer’s often have other health problems, including high blood pressure. Managing blood pressure is important because high blood pressure can increase the risk of stroke and heart disease, which can make dementia worse.
However, treating high blood pressure in people with Alzheimer’s is not always straightforward. The brain in Alzheimer’s disease is more sensitive to changes in blood pressure. Very low blood pressure, which can happen with strong blood pressure medications, might reduce blood flow to the brain and could potentially make thinking problems worse.
## What Does the Research Say?
Recent studies have looked at whether blood pressure medications, including amlodipine, are safe for people with dementia. One large study found that using antihypertensive drugs (which include amlodipine) was linked to a higher risk of serious side effects in people with dementia compared to those without dementia[1]. These side effects included falls, low blood pressure (hypotension), and fainting (syncope)[1].
The study showed that the absolute risk of having a serious fall was much higher in people with dementia (47 per 10,000 people per year) than in those without dementia (14 per 10,000 people per year)[1]. The risks of low blood pressure and fainting were also higher in the dementia group[1]. Importantly, the study did not find a higher risk of fractures, but the increased risk of falls is still a major concern, especially in older adults who are already at risk for injuries.
The authors of the study suggest that doctors, patients, and caregivers should carefully consider these risks before starting new blood pressure medications in people with dementia[1]. This does not mean that amlodipine should never be used in Alzheimer’s patients, but it does mean that the decision should be made carefully, weighing the benefits of lowering blood pressure against the risks of side effects.
## Other Factors to Consider
People with Alzheimer’s disease often take multiple medications for different health problems. This is called polypharmacy, and it can increase the risk of drug interactions and side effects[3]. Older adults, in general, are more sensitive to medications, and their bodies may process drugs differently than younger people. This is why it is especially important to review all medications regularly and to use the lowest effective dose.
Non-drug approaches to managing blood pressure, such as diet, exercise, and reducing salt intake, may also be helpful and could reduce the need for medications[5]. These strategies are often underused but can be important parts of care for people with Alzheimer’s disease.
## What Should Patients and Caregivers Do?
If you or a loved one has Alzheimer’s disease and high blood pressure, it is important to talk to your doctor about the risks and benefits of amlodipine and other blood pressure medications. Ask about non-drug options and whether it might be possible to lower the dose or stop certain medications if they are not clearly needed.
Regular monitoring is key. Blood pressure should be checked often, and any new symptoms, such as dizziness, falls, or confusion, should be reported to the doctor right away. Caregivers should also watch for signs of low blood pressure, such as feeling faint or lightheaded, especially when standing up.
## The Bottom Line
Amlodipine can be effective for lowering blood pressure in older adults, including those with Alzheimer’s disease[2]. However, research shows that people with dementia are at higher risk for serious side effects from blood pressure medications, including falls, low blood pressure, and fainting[1]. The decision to use amlodipine or any blood pressure medication in someone with Alzheimer’s should be made carefully, with input from the doctor, patient, and caregiver. Regular review of all medications and consideration of non-drug strategies are important parts of care for people with Alzheimer’s and high blood pressure.
Sources: [1], [2], [3]