S-Amlodipine: An Isomer with Difference—Time to Shift from Racemic Amlodipine

Table 4

Pleiotropic effects of S-amlodipine.

Author (year)	Country	S-AM; (mg)	Comparator; (mg)		Duration; (weeks)	Antihypertensive efficacy	Pleiotropic effect
Effect on Arterial stiffness and Endothelial function
RCTs
Liangjin et al. (2013) [33]	China	2.5–5	Nifed-SR (10)	40/40	12	SBPVR (mmHg); S-AM: to 12.1 ± 2.7 (); Nifed-SR: 14.8 ± 2.9 to 13.7 ± 3.2 (); DBPVR (mmHg); S-AM: 10.2 ± 1.8 to 8.5 ± 1.9 (); Nifed-SR: 10.2 ± 1.9 to 9.8 ± 2.5 ()	CIMT (per mm); S-AM: 1.24 ± 0.41 to 1.08 ± 0.28 (); Nifed-SR: 1.23 ± 0.31 to 1.22 ± 0.33
Zhang et al. (2003) [34]	China	2.5	Amlo (5)	60	6	NA	FMD%; S-AM: 4 ± 4 to 3 ± 4 (); Amlo: 6.7% to 6.8% ()
Guo et al. (2012) [35]	China	NA	Amlo	126/106	24	S-AM: 153.88/94.03 to 132.59/81.96 ( for both); Amlo: 152.21/93.3 to 133.22/82.47 ( for both)	Significant improvements in; central BP components; baPWV; ambulatory arterial stiffness index variability of ambulatory BP; (all ); CIMT: No significant changes
Si et al. (2014) [36] [crossover trial, 2-week washout]	China	2.5	Amlo (5)	24	6 × 6	SBP: 162 to 132 (Amlo) and 131 (S-AM) ( for both); DBP: 95 to 81 (Amlo) and 82 (S-AM) ( for both); HR: 76 to 72 (Amlo) and 73 (S-AM) ( for both)	FMD%: 5.7 to 8.0 (Amlo) and 7.3 (S-AM) ( for both); NMD%: 13.6 to 12.9 (Amlo) and 14.1 (S-AM); NO μmol/L: 42 to 62 (Amlo) and 59 (S-AM) ( for both); eNOS μ/L: 20 to 26 (Amlo) and 24 (S-AM) ( for both)
Observational study
Nestorovich (2013) [37] [S-AM + Enalapril versus enalapril]	Ukraine	5–10	E (10–20)	33/32	24	NR	Combination therapy had greater changes in; Maximal speed (max) of bloodstream in BA; (i) initial (22.8 and 17.6 cm/sec); (ii) after reactive hyperaemia (41.7 and 31.6 cm/sec),; Speed of retrograde wave: (i) initial (19.6 and 14.3 cm/sec); (ii) after reactive hyperaemia (25.9 and 20.2 cm/sec); (iii) post-occlusive dilatation (5.2% and 3.4%); Changes in endothelin-1 levels; (i) Combination: 3.86 ± 0.24 to 1.95 ± 0.19 pg/mL,; (ii) Enalapril alone: 3.32 ± 0.27 to 1.83 ± 0.21 pg/mL,
Effect on LV and BA function
Iskenderov and Saushkina (2013) [38]	Russia	-	Amlo	61/66	24	Comparable BP reduction at lower dose of S-AM	S-AM was associated with -; Complete regression of LVH: 51% cases; Normalization of LV diastolic function: 62.4% cases; Significant improvement in BA vasomotor function; Significant reduction in atherogenic lipoproteins and TC
Efficacy in renal transplant cases
Tang et al. (2003) [39]	China	2.5–5	Amlo	20	8	Significant reduction in; SBP (); DBP (); BUN ()	Normalization of BP in 85% cases; Improved renal function
Effect on insulin resistance [RCT]
Xiao et al. (2016) [40]	China	2.5–5	Losartan (50–100)	112/115	156	BP reduction was significant and similar in both groups	In both groups, significant reduction in fasting insulin; Increase in insulin sensitivity index
Effect on platelet aggregation and expression of MMP 2 and MMP 9
Li et al. (2013) [41]	China	NA	-	32	NA	NA	Reduced platelet aggregation maximal (%): 47.77 ± 11.92 to 40.78 ± 13.97 (); Platelet inhibition rate (%): 13.5 ± 25.23; No effect on MMP levels

AEs: adverse effects, Amlo: racemic amlodipine, BA: brachial artery, baPWV: brachial artery pressure wave velocity, BP: blood pressure, BUN: blood urea nitrogen, CIMT: carotid intima media thickness, DBP: Diastolic BP, DBPVR: DBP variety ratio, eNOS: endothelial nitric oxide synthase, FMD: flow-mediated dilation, HR: heart rate, LV: left ventricle, LVH: left ventricular hypertrophy, MMP: matrix metalloproteinase, NA: not available, Nifed-SR: nifedipine sustained release, NMD: nitroglycerine-mediated dilatation, NO: nitric oxide, NR: not reported, OR: odds ratio, RD: risk difference, S-AM: S-amlodipine, SBP: systolic BP, SBPVR: SBP variety ratio, and TC: total cholesterol.