table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you have high blood pressure, combination medications can be more effective than one drug alone.
Studies estimate that roughly 25% of blood pressure patients need at least three medications to effectively treat their high blood pressure––especially if it’s in an advanced stage. High blood pressure is also notoriously tricky to treat, which is why many people often fare better by taking more than one medication (Guerrero-Garcia, 2018).
But being on a three, four, or even five drugs per day schedule can be a tough regimen to follow. This is one big benefit of medications like amlodipine/benazepril: two medications in one pill. Let’s take a closer look at amlodipine/benazepril (brand name Lotrel) and how it treats high blood pressure.
What is amlodipine/benazepril?
Amlodipine/benazepril, also found under the brand name Lotrel, is an effective drug combination used to control high blood pressure.
As the name indicates, two different blood pressure drugs––amlodipine and benazepril––are blended in one pill. Amlodipine is a calcium channel blocker, which helps relax and keep blood vessels open (Bulsara, 2020). Benazepril is an ACE inhibitor, another class of drugs that treats high blood pressure similar to calcium channel blockers (Dahal, 2020).
Think of your blood vessels like a highway and your blood like the traffic on that highway. Many of the medications used to treat high blood pressure make those highways wider, like converting a two-lane street to an eight-lane road.
When there’s less traffic, your heart doesn’t need to work as hard to pump blood through the body. That’s especially important for people with heart failure, which is when the heart muscle isn’t strong enough to pump blood properly.
Typically, combination medications like amlodipine/benazepril are recommended for people whose blood pressure can’t be controlled with just one type of drug.
Even though high blood pressure itself often causes no symptoms at all, it increases your risk of severe and even deadly complications like heart attack and stroke. That means you need the most effective treatment possible, and this often comes in the form of combination drug therapy (Shao, 2018).
Who is most at risk of getting severe symptoms from COVID-19?
What are the benefits of combination blood pressure drugs?
Despite how common high blood pressure is and all the treatments available for it, it’s a condition that can be hard to treat. It’s also one that, left untreated, can have devastating consequences.
Millions of people live with high blood pressure, surpassed only by COVID-19 as the leading cause of death in the United States. It’s estimated that only one in four adults has their blood pressure under control––that’s a scary statistic considering that left untreated, high blood pressure can lead to heart failure, kidney disease, vision loss, and stroke (Dorans, 2018).
One of the most common reasons for poor blood pressure control is trouble sticking to treatment plans. Many factors can influence this, including difficulty adhering to medication schedules, failure by healthcare providers to adjust therapies as needed, and limited use of combination medications (Mancia, 2019).
Combination drug therapy is highly recommended for treating high blood pressure, especially for people whose blood pressure can’t be controlled with just one drug. Guidelines have been recently updated recommending combination medications as a first-line treatment for hypertension, along with heart-healthy lifestyle changes, which we’ll dig deeper into later (Williams, 2018).
Side effects of amlodipine/benazepril
Like any medication, there are some side effects to be aware of. Common ones include dizziness, cough, headache, and edema (swelling caused by fluid retention) (FDA, 2017).
This medication carries a black box warning from the U.S. Food and Drug Administration (FDA): do not take this medication if you’re pregnant. It can cause severe adverse reactions or death to the unborn baby. If you find out you’re pregnant while taking amlodipine/benazepril, stop using it and contact your healthcare provider. Other serious side effects to look out for include (FDA, 2017):
- Angioedema: Lotrel can trigger angioedema, a life-threatening allergic reaction that causes rapid swelling, particularly in the face and throat.
- Hyperkalemia: This occurs when there’s a build-up of potassium in the body. Many cases of hyperkalemia are mild, but if not treated, it can lead to life-threatening heart problems (AHA, 2016).
- Jaundice: While rare, this medication can lead to liver damage. An early indicator of this is jaundice, which is when the skin or whites of the eyes turn yellow.
- Kidney problems
- Low blood pressure: Since this medication works by reducing your blood pressure, sometimes it can lower your blood pressure too much. This can result in dizziness and even fainting. If you experience these side effects, contact your healthcare provider.
What is normal blood pressure?
Drug interactions and other warnings
There are more than 600 different drugs known to interact with Lotrel. While this isn’t the full list of potential interactions that can occur, here are some important ones to note (FDA, 2017):
- Drugs that increase potassium levels: Use caution combining amlodipine/benazepril with anything that may raise your potassium levels (like potassium-sparing diuretics or potassium supplements). Since this drug also increases potassium levels, you could be at risk of developing hyperkalemia (high blood potassium), which can be dangerous and even life-threatening.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Taking NSAIDs alongside amlodipine/benazepril could make the blood pressure medication less effective. NSAIDs, such as ibuprofen and naproxen, may also impact kidney function and lead to more serious problems, like kidney failure.
- Lithium: Amlodipine/benazepril can raise lithium levels in the body. If you’re taking lithium and Lotrel, monitor yourself carefully as there is a risk of a lithium overdose.
- Simvastatin: Simvastatin is a medication used to manage high cholesterol. Amlodipine/benazepril increases simvastatin levels in your body, which raises the risk for side effects.
- mTOR inhibitors: This class of drugs is often used in cancer treatments. Mixing mTOR inhibitors with amlodipine/benazepril could make you susceptible to angioedema, an allergic reaction that causes rapid swelling.
- Drugs that block the renin-angiotensin system (RAS): RAS inhibitors treat high blood pressure. Taken at the same time as amlodipine/benazepril could lead to hyperkalemia, low blood pressure, and reduced kidney function.
- Neprilysin inhibitors: Amlodipine/benazepril should not be combined with neprilysin inhibitors. These drugs are used to treat heart failure and used alongside Lotrel, increases your chance of angioedema.
Others who should use caution or avoid taking Lotrel altogether include nursing mothers, people over age 65, those with a history of angioedema, and other health conditions that affect the heart, liver, or kidneys.
Heart-healthy diet: what is it and 9 tips to following one
How to help keep your blood pressure down
Although high blood pressure is treatable, many people go years without knowing they’re affected. Even once you’re diagnosed, it can be challenging to maintain the rigorous treatment plans that often come with hypertension.
There’s no cure for high blood pressure, but along with medication, there are some simple steps you can take on your own to improve blood pressure control.
Eat a well-balanced diet and avoid foods that are processed or high in sodium. This, along with regular exercise, can help you maintain a healthy weight. Try to limit alcohol use and quit smoking. All of these things––coupled with working with a healthcare provider to find the best treatment plan for you—can reduce high blood pressure and prevent the risk of worse health issues down the road (Tsai, 2020).
- Bulsara, K.G. & Cassagnol, M. (2020). Amlodipine. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519508/
- Dahal, S. S. & Gupta M. (2021). Benazepril. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549885/
- Dorans, K. S, Mills, K. T., Liu, Y., & He, J. (2018). Trends in Prevalence and Control of Hypertension According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline. Journal of the American Heart Association, 7: e008888. doi: 10.1161/JAHA.118.008888. Retrieved from https://www.ahajournals.org/doi/10.1161/JAHA.118.008888
- Guerrero-García, C. & Rubio-Guerra, A. F. (2018). Combination therapy in the treatment of hypertension. Drugs in Context, 7, 212531. doi: 10.7573/dic.212531. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992964/
- Mancia, G., Rea, F., Corrao, G., & Grassi, G. (2019). Two-Drug Combinations as First-Step Antihypertensive Treatment. Circulation Research, 124: 1113–1123. doi: 10.1161/CIRCRESAHA.118.313294. Retrieved from https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.118.313294
- Shao, L., Chan, P., Tomlinson, B., Zhang, Y., & Liu, Z. M. (2019) Single-pill combinations for hypertension: first line treatment for all? Current Medical Research and Opinion, 35(1), 113-115. doi: 10.1080/03007995.2018.1541444. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30362846/
- Tsai, M. C., Lee, C. C., Liu, S. C., Tseng, P. J., & Chien, K. L. (2020). Combined healthy lifestyle factors are more beneficial in reducing cardiovascular disease in younger adults: a meta-analysis of prospective cohort studies. Scientific Reports, 10, 18165. doi: 10.1038/s41598-020-75314-z. Retrieved from https://www.nature.com/articles/s41598-020-75314-z#citeas
- U.S. Food and Drug Administration (FDA). (2017, July). Lotrel. Retrieved Dec. 22, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020364s065lbl.pdf
- Williams, B., Mancia, G., Spiering, W., Rosei, E. A., Azizi, M., Burnier, M., et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal, 39(33), 3021–3104. doi: 10.1093/eurheartj/ehy339. Retrieved from https://academic.oup.com/eurheartj/article/39/33/3021/5079119
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.