What exactly is the incidence of the lower extremity edema we see from amlodipine?
Primary studies estimate the answer to be somewhere between 33% and 47%. This clustering was pretty reasonable, although there was one study that reported a subjective swelling rate of 64%!
I also learned about other CCBs like lacidipine and lercanidipine which have lower rates of LE edema than amlodipine.
The article I'm sharing with you is a fun one where they started patients on amlodipine and then gave them either (a) more amlodipine, (b) hydrochlorothiazide, or (c) benazapril. Both hctz and benazapril improved the edema. They both improved BP as well, but as the study compared 25mg of hctz with 20mg of benazapril - not fair in my opinion - I'm not drawing any conclusion that ACEI > thiazide.
Table 3. Water displacement results in patients with at least 10% increase in volume during phase 2
Finally I will point you to this reference which found that 1.4% of patients prescribed amlodipine subsequently got a related prescription for a loop diuretic (the point being be careful about the potential for prescribing cascades). Hopefully this helps you counsel your patients in clinic!
Vouri SM, Jiang X, Manini TM, et al. Magnitude of and Characteristics Associated With the Treatment of Calcium Channel Blocker–Induced Lower-Extremity Edema With Loop Diuretics. JAMA Network Open. 2019;2(12):e1918425-e1918425.
Weir M. Pilot study to evaluate a water displacement technique to compare effects of diuretics and ACE inhibitors to alleviate lower extremity edema due to dihydropyridine calcium antagonists. American Journal of Hypertension. 2001;14(9):963-968.
