Hiremath, JMohan, JCAbdullakutty, JBansal, SDalal, JHazra, PKRao, SShah, VTKubba, S.2025-08-132025-08-132025-04Hiremath J, Mohan JC, Abdullakutty J, Bansal S, Dalal J, Hazra PK, Rao S, Shah VT, Kubba S.. Beyond Amlodipine—The Case for S-amlodipine as the First Choice Calcium Channel Blocker: An Expert Opinion from India. Journal of the Association of Physicians of India. 2025 Apr; 73(4): 33-390004-5772https://imsear.searo.who.int/handle/123456789/251971Background: Calcium channel blockers (CCBs) have been recommended as the first-line treatment option for the management of hypertension. Amlodipine has been used to treat hypertension over the past 3 decades. However, the chief limitation of amlodipine is pedal edema; it is associated with poor adherence to therapy. Amlodipine is a racemic mixture of two stereoisomers [R(+), S(–)]. Only the S(–) isomer exerts vasodilating action. The R-amlodipine isomer is considered to cause adverse effects. Aim: To understand the place of S-amlodipine and its combinations in the management of hypertension and related cardiovascular (CV) disorders in the real-world setting in India. Methodology: A conclave of nine Indian cardiologists was formed to discuss the place of S-amlodipine in the management of hypertension in their clinical practice. Results: The antihypertensive efficacy of S-amlodipine is comparable to that of amlodipine. S-amlodipine does not cause pedal edema. In fact, switching patients on amlodipine who develop pedal edema to S-amlodipine is helpful in improving patient compliance. However, it would be prudent to initiate treatment with S-amlodipine itself rather than amlodipine, which causes pedal edema. S-amlodipine does not cause gingival hypertrophy, and this improves patient compliance. S-amlodipine consistently lowers blood pressure (BP) across different patient populations such as young, elderly, and patients with CV risk factors. Conclusion: S-amlodipine has antihypertensive, antianginal actions, and pleiotropic effects. S-amlodipine 2.5 mg is found to be equivalent in its efficacy and tolerability when compared to amlodipine 5 mg in the treatment of mild to moderate hypertension.Journal ArticleIndiaDirector, Department of Cardiology, Cath Lab, Ruby Hall Clinic, Pune, Maharashtra, IndiaChairman, Department of Cardiology, Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, New Delhi, IndiaSenior Consultant Cardiologist and Director of Clinical Research, Department of Cardiology, Lisie Hospital, Kochi, Kerala, IndiaConsultant and HOD, Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, IndiaDirector and Interventional Cardiologist, Department of Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, IndiaHead, Department of Cardiology, Director of Cardiac Cath Laboratory, AMRI Hospitals, Kolkata, West Bengal, IndiaSenior Interventional Cardiologist and Director, Department of Cardiology, Cath Lab, Apollo Hospitals, Indore, Madhya Pradesh, IndiaDirector, Department of Cardiology, Surana Sethia Hospital, Mumbai, Maharashtra, IndiaDirector and Unit Head, Narayana Dharamshila Superspeciality Hospital; Director, Mohan Heart Care Clinic, New Delhi, Delhi, India