Is initial dose titration of amlodipine worthwhile in patients with mild to moderate hypertension?

Amlodipine, a dihydropyrimidine calcium antagonist, is effective in the tre atment of patients with mild to moderate hypertension at doses of 5-10 mg d aily. The aim of the study reported here was to determine whether an early increase in dosage of amlodipine provided an advantage in terms of antihype rtensive effect. This was a single-blind, randomised study in 115 patients with mild to moderate hypertension (diastolic blood pressure 95-114 mmHg) c onducted at 10 centres with two parallel groups. Group I received amlodipin e 4 mg once daily for the entire 10-week treatment period, while group II r eceived amlodipine 5 mg once daily for two weeks, with the option to increa se the dose to 10 mg once daily were the diastolic blood pressure to exceed 90 mmHg. The dose was increased in 40% of group II patients (20/50). Diast olic and systolic blood pressure decreased steadily until the end of the si xth week of treatment in both groups, with no statistically significant dif ference between the groups. The response rare (diastolic blood pressure les s than or equal to 90 mmHg) at the end treatment was 84 % in both groups. B ecause there is no advantage in an early increase in dosage of amlodipine i n terms of antihypertensive effect, a dose increase should not be considere d until after six weeks of treatment at 5 mg once daily.