What Is Better Than Amlodipine for High Blood Pressure?

October 13, 2025 •

4 min read

According to a 2021 study in the journal Hypertension, patients starting blood pressure medication frequently have their prescription tailored based on factors beyond efficacy, such as a lower likelihood of serious side effects. For those asking, "What is better than amlodipine for high blood pressure?", the answer often depends on an individual's specific health needs and tolerability.

Quick Summary

Several alternatives exist for individuals who find amlodipine ineffective or experience side effects, including other calcium channel blockers, ACE inhibitors, ARBs, and diuretics. Selecting the best medication depends on a patient's overall health and is determined in consultation with a doctor.

Key Points

Identify the problem: Consider switching from amlodipine if you experience intolerable side effects, like ankle swelling, or if your blood pressure remains uncontrolled.
Understand other drug classes: Alternatives like ACE inhibitors (e.g., lisinopril) and ARBs (e.g., losartan) work differently and may have different side effects.
Choose based on side effects: If amlodipine causes ankle swelling, an ACE inhibitor or ARB may be preferable, as they are less likely to cause this side effect.
Consider comorbidities: Your doctor will select an alternative based on other health conditions, such as heart failure or kidney disease.
Explore combination therapy: For difficult-to-control blood pressure, adding a second medication, such as a diuretic, may be more effective than a single-drug switch.
Prioritize medical guidance: Always consult a healthcare provider before making any changes to your medication, as the best choice is highly individualized.

For many patients, amlodipine is a safe and effective treatment for hypertension. However, side effects like ankle swelling (peripheral edema) or insufficient blood pressure control can prompt a search for alternatives. Instead of a single "better" medication, healthcare providers consider multiple classes of drugs, each with a different mechanism of action and side effect profile, to find the most suitable option for an individual. The optimal choice is always based on a thorough medical evaluation of a patient's health, comorbidities, and response to treatment.

Reasons to Switch from Amlodipine

Switching or adjusting hypertension medication is common. Primary motivations for finding a new medication include:

Intolerable Side Effects: Peripheral edema (swelling of the ankles, feet, or hands) is a well-known side effect of amlodipine that can be a major issue for some patients. Other potential side effects include headaches, dizziness, fatigue, and flushing.
Lack of Efficacy: Amlodipine may not be sufficient to control blood pressure, particularly in more severe cases. In such situations, adding a second medication or changing to a different class may be necessary.
Comorbidities: Certain health conditions, such as kidney disease or heart failure, might make a different class of medication more beneficial.
Drug Interactions: A healthcare provider may need to change the medication if new medications are started that interact with amlodipine.

Alternatives to Amlodipine for High Blood Pressure

There are several major classes of medications that serve as effective alternatives to amlodipine:

Other Calcium Channel Blockers (CCBs)

If a patient experiences side effects from amlodipine, another CCB might be a suitable replacement. Other dihydropyridine CCBs, such as felodipine or nifedipine, work similarly but can have different side effect profiles. Lercanidipine, for example, is associated with a lower risk of edema compared to amlodipine. Non-dihydropyridine CCBs like diltiazem and verapamil have different actions and can be effective for managing both hypertension and angina, but they affect heart rate more directly.

ACE (Angiotensin-Converting Enzyme) Inhibitors

ACE inhibitors block the production of a substance called angiotensin II, which narrows blood vessels. By preventing this action, they help relax blood vessels and lower blood pressure. Examples include lisinopril, ramipril, and benazepril. A common side effect is a persistent dry cough, which affects a small but significant portion of patients. For those who develop the cough, ARBs are typically the next option.

Angiotensin II Receptor Blockers (ARBs)

ARBs work by blocking the action of angiotensin II at the receptor level, with an effect similar to ACE inhibitors but through a different mechanism. This makes them an excellent alternative for patients who cannot tolerate the cough from ACE inhibitors. Common ARBs include losartan, valsartan, and telmisartan.

Diuretics

Diuretics, also known as "water pills," help the kidneys flush excess sodium and water from the body, which reduces blood volume and pressure. They are often used as first-line therapy, particularly in patients with fluid retention or in combination with other medications. A commonly used thiazide diuretic is hydrochlorothiazide.

Beta-Blockers

Beta-blockers work by blocking the effects of adrenaline, causing the heart to beat more slowly and with less force. They are particularly useful for patients with heart conditions like angina or certain heart rhythm disorders. Examples include metoprolol, carvedilol, and atenolol. Side effects can include fatigue and dizziness.

Comparison of Blood Pressure Medications


Medication Class	Example(s)	Mechanism of Action	Common Side Effects	Best for...
Amlodipine (CCB)	Amlodipine	Relaxes blood vessels by blocking calcium channels.	Ankle swelling, dizziness, fatigue, flushing.	Patients who respond well without major side effects. Also used for angina.
ACE Inhibitors	Lisinopril, Ramipril	Blocks the enzyme that produces a blood-vessel constrictor.	Dry cough, dizziness. Not recommended during pregnancy.	Patients with heart failure or chronic kidney disease.
ARBs	Losartan, Valsartan	Blocks the receptor for the blood-vessel constrictor.	Dizziness, upper respiratory infection. Avoids ACE inhibitor cough.	Patients who develop a cough from ACE inhibitors. Losartan can protect kidneys in Type 2 diabetes.
Diuretics	Hydrochlorothiazide	Helps kidneys remove excess sodium and water.	Electrolyte imbalances, increased urination.	Patients with fluid retention. Often effective as a first-line treatment.
Beta-Blockers	Metoprolol, Carvedilol	Slows heart rate and reduces force of contractions.	Fatigue, dizziness, low energy.	Patients with coexisting angina or specific heart rhythm disorders.

Making the Right Choice: Discussion and Medical Guidance

When a healthcare provider decides that a change from amlodipine is appropriate, they will consider a number of factors:

The reason for the change: Is it for side effects or lack of efficacy? If it is a side effect, they may opt for a different drug class. If it's for efficacy, adding a second medication or increasing the dose might be considered.
Existing health conditions: The presence of conditions like diabetes, heart failure, or kidney disease will influence the selection.
Patient history: Past medical history and genetic factors can play a role. For example, guidelines may recommend certain medication classes over others for specific ethnic groups.

For many, especially those who struggle to achieve target blood pressure with a single drug, combination therapy is the most effective approach. A doctor may add a diuretic or an ACE inhibitor to amlodipine rather than switching completely. Lifestyle modifications, including dietary changes and exercise, also remain a critical component of any hypertension treatment plan and can even reduce the need for certain medications.

Conclusion

Ultimately, what is better than amlodipine for high blood pressure is not a single drug but the treatment plan that works best for a patient's unique situation. While amlodipine is a potent and widely used medication, alternatives like ACE inhibitors, ARBs, diuretics, or other CCBs offer solutions for individuals experiencing intolerable side effects or insufficient blood pressure control. The decision to switch medications should always be a collaborative process between a patient and their healthcare provider, who can weigh the risks and benefits of each option to find the safest and most effective solution. Regular monitoring and open communication are key to successful, long-term hypertension management.

For further reading on the guidelines for treating hypertension, the American Heart Association provides extensive resources.

Frequently Asked Questions

People may need an alternative to amlodipine due to intolerable side effects, such as ankle swelling or fatigue, or if the medication is not effectively controlling their high blood pressure.

Yes, lisinopril (an ACE inhibitor) is a common alternative to amlodipine for those experiencing peripheral edema, as it does not typically cause this type of swelling. However, lisinopril can cause a dry cough in some patients.

Amlodipine is a calcium channel blocker that relaxes blood vessels, while losartan is an angiotensin II receptor blocker (ARB) that blocks a hormone that constricts blood vessels. Both are effective, but they work through different mechanisms and have different side effect profiles.

For some patients, especially those with more severe or resistant hypertension, combining two medications (like amlodipine and an ACE inhibitor) can be more effective at lowering blood pressure than using a single medication alone.

The primary advantage of an ARB (like losartan) over an ACE inhibitor (like lisinopril) is the absence of the dry, persistent cough that some patients experience with ACE inhibitors.

Yes, lifestyle modifications, including regular exercise, following a low-sodium diet like the DASH eating plan, and maintaining a healthy weight, are essential for managing hypertension and may reduce or even eliminate the need for medication in some cases.

Never switch or stop a medication on your own. You should consult with your doctor, who will determine the best alternative based on your specific needs. They will provide a plan for safely transitioning to the new medication while monitoring your blood pressure closely.