Amlodipine: NHS prescribing information and NICE guidance

NICE guideline NG136 (Hypertension in adults: diagnosis and management) provides a clear, evidence-based pathway for blood pressure treatment.

Amlodipine occupies a prominent position in this pathway.

Who should be offered amlodipine first?

NICE recommends a calcium channel blocker (such as amlodipine) as first-line monotherapy for:

• Adults aged 55 and over with stage 1 hypertension (clinic BP 140-159/90-99 mmHg) and a 10-year cardiovascular risk of 10% or more
• Adults of Black African or Black Caribbean family origin at any age
• Patients who cannot tolerate ACE inhibitors or ARBs

Treatment steps:

• Step 1: amlodipine alone (or ACE inhibitor/ARB for those under 55)
• Step 2: combine amlodipine with an ACE inhibitor or ARB
• Step 3: add a thiazide-like diuretic to make triple therapy
• Step 4: for resistant hypertension, consider adding spironolactone (if potassium is 4.5 mmol/L or less)

Blood pressure targets:

• Under 80 years: clinic BP below 140/90 mmHg (ABPM/home BP below 135/85 mmHg)
• 80 years and over: clinic BP below 150/90 mmHg (ABPM/home BP below 145/85 mmHg)

I always explain the NICE pathway to my patients, as understanding where amlodipine fits in the overall treatment strategy helps with adherence and motivation.

Amlodipine is a prescription-only medicine. It is not available over the counter. Here is how the process works.

Diagnosis of hypertension:

Before prescribing amlodipine, your GP will follow the NICE diagnostic pathway:

1. Clinic blood pressure: if your clinic reading is 140/90 mmHg or above, further assessment is needed
2. Ambulatory blood pressure monitoring (ABPM): you wear a device for 24 hours that takes readings every 30 minutes. This is the gold standard for diagnosis
3. Home blood pressure monitoring (HBPM): an alternative to ABPM, taking readings twice daily for at least 4 days
4. Cardiovascular risk assessment: QRISK3 score to determine your overall risk

Starting amlodipine:

• Your GP will prescribe amlodipine 5 mg once daily (or 2.5 mg if elderly or liver impairment)
• Baseline blood tests: full blood count, renal function, electrolytes, lipid profile, HbA1c
• Urine test: albumin to creatinine ratio to screen for kidney involvement

Ongoing prescriptions:

• Once stable, amlodipine is issued as a repeat prescription
• Electronic repeat dispensing means your pharmacy receives prescriptions automatically
• Annual review with blood tests and blood pressure check

Cost:

Generic amlodipine is extremely cost-effective. Standard NHS prescription charges apply in England.

Prescriptions are free in Scotland, Wales and Northern Ireland, and for exempt groups in England (over 60, under 16, etc.).

Regular monitoring is essential for all patients on blood pressure medication. The NHS provides a structured approach through GP practices and community pharmacies.

Annual hypertension review:

Your GP practice should offer an annual review that includes:

• Blood pressure measurement (ideally using an automated device without the white-coat effect)
• Review of cardiovascular risk factors
• Blood tests: renal function, electrolytes, lipid profile, HbA1c
• Medication review: assessing adherence, side effects and whether the current dose is appropriate
• Lifestyle discussion: diet, exercise, smoking, alcohol

Home monitoring:

NICE recommends home blood pressure monitoring as part of ongoing management. Many GP practices loan monitors to patients, and validated devices are available to purchase for around 20 to 30 pounds.

Community pharmacy services:

• NHS Blood Pressure Check Service: adults aged 40 and over can get a free blood pressure check at participating pharmacies without a GP appointment
• New Medicine Service (NMS): if you have just started amlodipine, your pharmacist may offer follow-up calls at 7 and 14 days to check for side effects and answer questions
• Medicines Use Review (MUR): an in-depth review of all your medications

NHS Health Check:

Every adult in England aged 40 to 74 without a pre-existing cardiovascular condition is entitled to a free NHS Health Check every 5 years.

This includes blood pressure assessment, cholesterol testing and cardiovascular risk scoring. It is often the first time hypertension is detected.

The NHS and NICE emphasise that lifestyle modification is a cornerstone of hypertension management, both alongside and in some cases before medication.

Salt reduction:

• Aim for less than 6 g of salt per day (about one teaspoon)
• Check food labels: many processed foods, bread and cereals contain hidden salt
• Reducing salt intake by 6 g per day can lower systolic blood pressure by approximately 5 mmHg

Diet:

• Follow the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean-style pattern
• Increase fruit and vegetable intake to at least 5 portions daily
• Choose whole grains over refined carbohydrates
• Include potassium-rich foods (bananas, potatoes, spinach) which help counteract the effects of sodium

Physical activity:

• At least 150 minutes of moderate-intensity activity per week
• Even 10-minute bouts of brisk walking count towards your weekly total
• Regular exercise can lower systolic BP by 5 to 8 mmHg

Weight management:

• Maintaining a healthy BMI (18.5 to 24.9) significantly improves blood pressure control
• NHS weight management programmes are available through GP referral

Alcohol:

• Keep within 14 units per week, spread over at least 3 days
• Reducing alcohol intake can lower blood pressure within weeks

Smoking:

• While smoking does not directly cause sustained hypertension, it dramatically increases cardiovascular risk
• The NHS Stop Smoking Service is free and highly effective

These measures can reduce the need for higher doses of amlodipine and, in some cases, allow dose reduction over time.

Proactive monitoring and timely medical review are essential for good blood pressure management.

Book a routine GP appointment if:

• Your home blood pressure readings are consistently above 135/85 mmHg despite taking amlodipine as prescribed
• You are experiencing side effects that are affecting your quality of life
• You want to discuss whether your dose could be adjusted
• You have not had a blood pressure review in the last 12 months
• You are planning to become pregnant (amlodipine should be switched to a pregnancy-safe alternative)

Seek urgent medical advice if:

• Your blood pressure reading is above 180/120 mmHg (hypertensive crisis)
• You have a severe headache with visual disturbance, nausea or confusion
• You experience chest pain, breathlessness or one-sided weakness (possible stroke or heart attack: call 999 immediately)
• You feel dizzy, faint or have collapsed (possible over-treatment or interaction)

NHS 111:

If you are unsure whether your symptoms need urgent attention, NHS 111 (call 111 or visit 111.nhs.uk) provides 24-hour assessment and can advise whether you need to attend A&E or see a GP urgently.

Remember: hypertension is a silent condition. Regular monitoring is the only way to ensure your blood pressure is well controlled.

Take an active role in your care by attending your annual reviews and monitoring at home.