Comparative trends and effectiveness of amlodipine and nifedipine as oral antihypertensives in preeclampsia management

Authors

  • Adila Awaludin Department of Pharmacy, Universitas Perjuangan Tasikmalaya
  • Ayu Rahmawati Department of Pharmacy, Perjuangan University, Tasikmalaya
  • Annisa Annisa Department of Pharmacy, Perjuangan University, Tasikmalaya
  • Gina Septiani Agustien Department of Pharmacy, Perjuangan University, Tasikmalaya

DOI:

https://doi.org/10.12928/pharmaciana.v15i1.30269

Keywords:

amlodipine, antihypertensive, gestational hypertension, nifedipine, preeclampsia

Abstract

The use of amlodipine in preeclampsia remains limited as it is not a treatment option officially. Whereas amlodipine's long half-life allows less frequent dosing in preeclampsia patients, potentially improving preeclampsia treatment more efficiently compared to nifedipine (standard medicine). Ensuring the effectiveness of amlodipine for preeclampsia is essential for optimizing delivery outcomes, in addition to efficiency aspects. However, the effectiveness study of amlodipine in preeclampsia patients is still not definitively known. This study aims to determine the prescription trends and effectiveness of amlodipine as an antihypertensive in preeclampsia. The study used a cross-sectional approach conducted at a one of the secondary healthcare facilities in Tasikmalaya, utilizing medical records from January 2019 to December 2023. The data were analyzed using Chi-Square test to determine the trends using and effectiveness of amlodipine compared to nifedipine in controlling blood pressure in preeclampsia. The study shows that the trends using of amlodipine in preeclampsia is decreasing over the past 5 years (2019 to 2023). This phenomenon may be influenced by limited evidence, established clinical practice guidelines, and priority of drug use. There was no significant difference in effectiveness of amlodipine compared to nifedipine in single therapy (p= 0.698) or dual therapy (p=0.1). Furthermore, the study found that amlodipine and nifedipine exhibited comparable effectiveness in controlling blood pressure in preeclampsia. Therefore, amlodipine may be considered as an alternative antihypertensive option for controlling blood pressure in preeclampsia.

References

Abdurrahman, A., Adamu, A. N., Ashimi, A., Adekunle, O. O., Bature, S. B., Aliyu, L. D., Akeem, O., Abdullahi, H., Lavin, T., Daneji, S., Musa, B., Muazu, Z., Tukur, J., & Galadanci, H. S. (2024). Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities. BJOG: An International Journal of Obstetrics & Gynaecology, 131(S3), 42–54. https://doi.org/10.1111/1471-0528.17902

Abernethy, D. R. (1992). Pharmacokinetics and pharmacodynamics of amlodipine. Cardiology, 80(1), 31–36. https://doi.org/10.1159/000175050

Ackerman, C. M., Platner, M. H., Spatz, E. S., Illuzzi, J. L., Xu, X., Campbell, K. H., Smith, G. N., Paidas, M. J., & Lipkind, H. S. (2019). Severe cardiovascular morbidity in women with hypertensive diseases during delivery hospitalization. American Journal of Obstetrics and Gynecology, 220(6), 582.e1-582.e11. https://doi.org/10.1016/j.ajog.2019.02.010

ACOG. (2020). Clinical management guidelines for obstetrician – gynecologists gestational hypertension and preeclampsia. In ACOG Pracice Bulletin No. 222,135 (6).

Agustin, S. P., Tunom, S., & Puspitaloka Mahadewi, E. (2023). Factors analysis influencing on demand for private health insurance in Indonesia after pandemic. International Journal of Science, Technology & Management, 4(4), 963–971. https://doi.org/10.46729/ijstm.v4i4.898

Akbar, M. A., Ilham, Bachnas, M. A., Mose, J. C., Dachlan, E. G., Ernawati, E., Dekker, G. A., Staff, A. C., Sulistyowati, S., Dewantiningrum, J., Jayakusuma, A., Wantanai, J., Sitepu, M., Effendi, J. S., & Kristanto, H. (2018). The massive problem of preeclampsia in indonesia: In need of a redesigned national health care system. Pregnancy Hypertension, 13, S16. https://doi.org/10.1016/j.preghy.2018.08.051

Al Ismaili, A., Al-Duqhaishi, T., Al Rajaibi, H., Al Waili, K., Al Rasadi, K., Nadar, S. K., & Al Hashmi, K. (2022). Antihypertensive drugs and perinatal outcomes in hypertensive women attending a specialized tertiary hospital. Oman Medical Journal, 37(2), e354–e354. https://doi.org/10.5001/omj.2022.43

Awaludin, A., Nurzaman, M. H., Annisa, & Herdianti, N. (2023). Hubungan penggunaan kombinasi antihipertensi dengan luaran neonatal pada pasien preeklamsia. MPI (Media Pharmaceutica Indonesiana), 5(2), 156–164. https://doi.org/10.24123/mpi.v5i2.6072

Awaludin, A., Rahayu, C., Daud, N. A. A., & Zakiyah, N. (2022). Antihypertensive medications for severe hypertension in pregnancy: a systematic review and meta-analysis. Healthcare, 10(2), 325. https://doi.org/10.3390/healthcare10020325

Bain, A. (2019). Use of calcium channel blockers in cardiovascular disease. British Journal of Cardiac Nursing, 14(2), 64–70. https://doi.org/10.12968/bjca.2019.14.2.64

Bugri, A. A., Gumanga, S. K., Yamoah, P., Frimpong, E. K., & Nlooto, M. (2023). Prevalence of hypertensive disorders , antihypertensive therapy and pregnancy outcomes among pregnant women : a retrospective review of cases at tamale teaching hospital , ghana, 20(12), 1-12. https://doi.org/10.3390/ijerph20126153

Chang, K.-J., Seow, K.-M., & Chen, K.-H. (2023). Preeclampsia: recent advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. International Journal of Environmental Research and Public Health, 20(4), 2994. https://doi.org/10.3390/ijerph20042994

Chappell, L. C., Brocklehurst, P., Green, M. E., Hunter, R., Hardy, P., Juszczak, E., Linsell, L., Chiocchia, V., Greenland, M., Placzek, A., Townend, J., Marlow, N., Sandall, J., & Shennan, A. (2020). Planned early delivery or expectant management for late preterm preeclampsia (PHOENIX): a randomized controlled trial. Obstetric Anesthesia Digest, 40(3), 136–137. https://doi.org/10.1097/01.aoa.0000693736.15905.d4

Drambarean, B., Mastalerz, J., Wendt, L., & Toth‐Manikowski, S. (2023). Pharmacotherapy considerations in pregnant patients on hemodialysis. Hemodialysis International, 27(3), 212–223. https://doi.org/10.1111/hdi.13107

Elliott, W. J., & Ram, C. V. S. (2011). Calcium channel blockers. The Journal of Clinical Hypertension, 13(9), 687–689. https://doi.org/10.1111/j.1751-7176.2011.00513.x

Garcia, J. E., Mulrenin, I. R., Nguyen, A. B., Loop, M. S., Daubert, M. A., Urrutia, R., & Lee, C. R. (2023). Antihypertensive medication use during pregnancy in a real-world cohort of patients diagnosed with a hypertensive disorder of pregnancy. Frontiers in Cardiovascular Medicine, 10. 1-9. https://doi.org/10.3389/fcvm.2023.1225251

Gordon, N. F. (2013). Clinical effectiveness of lifestyle management programs: importance of the class effect paradox. Current Treatment Options in Cardiovascular Medicine, 15(6), 675–680. https://doi.org/10.1007/s11936-013-0271-4

Hazfiarini, A., Zahroh, R. I., Akter, S., Homer, C. S. E., & Bohren, M. A. (2022). Indonesian midwives’ perspectives on changes in the provision of maternity care during the COVID-19 pandemic: A qualitative study. Midwifery, 108, 103291. https://doi.org/10.1016/j.midw.2022.103291

Hissen, S. L., Takeda, R., Badrov, M. B., Arias-Franklin, S., Patel, S., Nelson, D. B., Babb, T. G., & Fu, Q. (2024). Impact of maternal obesity on resting muscle sympathetic nerve activity during uncomplicated pregnancy: a longitudinal assessment. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 326(1), R10–R18. https://doi.org/10.1152/ajpregu.00098.2023

Hou, L., Li, J., Zhao, R., Liu, L., Zhang, W., & Zou, L. (2024). Clinical risk factors and protective factors of preeclampsia in China. 1-12. https://doi.org/10.21203/rs.3.rs-3825332/v1

Huang, Q., Sheng, C., Li, Y., Dou, Y., Zheng, M., Zhu, Z., & Wang, J. (2019). A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension. The Journal of Clinical Hypertension, 21(5), 648–657. https://doi.org/10.1111/jch.13543

Husna, N., Melinda, C., Sugita, R. D., & Anggraeni, R. (2023). Studi faktor resiko, pola pengobatan, dan luaran klinis pasien preeklampsia di RSUD Sleman Yogyakarta. Jurnal Sains Farmasi & Klinis, 9(sup), 196. https://doi.org/10.25077/jsfk.9.sup.196-201.2022

Kaye, A. B., Bhakta, A., Moseley, A. D., Rao, A. K., Arif, S., Lichtenstein, S. J., Aggarwal, N. T., Volgman, A. S., & Sanghani, R. M. (2019). Review of cardiovascular drugs in pregnancy. Journal of Women’s Health, 28(5), 686–697. https://doi.org/10.1089/jwh.2018.7145

Khumaeni, E. H., Mildawati, R., & Prasetyawan, F. (2023). The evaluation of the use of antihypertensive drugs with ATC & DDD method in cardiac Poly geriatric patient at Ajibarang Hospitas inpatient instalation. 1(1), 7–20. https://doi.org/https://doi.org/10.55927/ijcs.v1i1.7292

Kikuchi, D., Obara, T., Miura, R., Suzuki, N., Hirakawa, H., Josaka, R., Ito, M., Tokunaga, M., Usui, K., & Okada, K. (2022). Antihypertensive drug prescription trends for pregnant women with hypertension in acute hospitals in Japan. Hypertension Research, 45(9), 1441–1446. https://doi.org/10.1038/s41440-022-00956-7

Kwatra, S., Taneja, G., & Nasa, N. (2012). Alternative routes of drug administration- transdermal, pulmonary & parenteral. Indo Global Journal of Pharmaceutical Sciences, 02(04), 409–426. https://doi.org/10.35652/IGJPS.2012.47

Lee, E. M. (2023). Calcium channel blockers for hypertension: old, but still useful. Cardiovascular Prevention and Pharmacotherapy, 5(4), 113–125. https://doi.org/10.36011/cpp.2023.5.e16

Lowe, S. A., Brown, M. A., Dekker, G. A., Gatt, S., Mclintock, C. K., Mcmahon, L. P., Mangos, G., Moore, M. P., Muller, P., Paech, M., & Walters, B. (2009). Guidelines for the management of hypertensive disorders of pregnancy 2008. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49(3), 242–246. https://doi.org/10.1111/j.1479-828X.2009.01003.x

Magee, L. A., Brown, M. A., Hall, D. R., Gupte, S., Hennessy, A., Karumanchi, S. A., Kenny, L. C., McCarthy, F., Myers, J., Poon, L. C., Rana, S., Saito, S., Staff, A. C., Tsigas, E., & von Dadelszen, P. (2022). The 2021 international society for the study of hypertension in pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension, 27, 148–169. https://doi.org/10.1016/j.preghy.2021.09.008

Magee, L. A., Singer, J., Lee, T., McManus, R. J., Lay-Flurrie, S., Rey, E., Chappell, L. C., Myers, J., Logan, A. G., & von Dadelszen, P. (2020). Are blood pressure level and variability related to pregnancy outcome? Analysis of control of hypertension in pregnancy study data. Pregnancy Hypertension, 19, 87–93. https://doi.org/10.1016/j.preghy.2019.12.002

Malha, L., & August, P. (2019). Safety of antihypertensive medications in pregnancy: living with uncertainty. Journal of the American Heart Association, 8(15). https://doi.org/10.1161/JAHA.119.013495

Mayrink, J., Souza, R. T., Feitosa, F. E., Rocha Filho, E. A., Leite, D. F., Vettorazzi, J., Calderon, I. M., Sousa, M. H., Costa, M. L., Baker, P. N., Cecatti, J. G., Parpinelli, M. A., Fernandes, K. G., Guida, J. P., Santana, D. S., Barbosa, R. M., Galvao, R. B. F., Cassettari, B. F., Pfitscher, L., … Silva, M. A. (2019). Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study. Scientific Reports, 9(1), 9517. https://doi.org/10.1038/s41598-019-46011-3

Mishra, S., Kotur, P., Kaveriappan, G., & Thumjaa, A. (2024). Association of HbA1c value in early pregnancy in nondiabetic pregnant woman with obstetric outcome: a prospective observational study. Journal of South Asian Federation of Obstetrics and Gynaecology, 16(2), 103–106. https://doi.org/10.5005/jp-journals-10006-2391

Njoroge, S., Kuriloff, M., Mueller, A., Lopes Perdigao, J., Dhir, R., & Rana, S. (2021). The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center. Pregnancy Hypertension, 25, 7–11. https://doi.org/10.1016/j.preghy.2021.05.009

Ozyuncu, N., & Erol, C. (2024). How can we increase the efficacy of antihypertensive treatment? Kardiologia Polska, 82(1), 19–28. https://doi.org/10.33963/v.kp.98705

PERKI. (2021). Panduan tatalaksana penyakit Kardiovaskular pada kehamilan (I).

POGI. (2016). PNPK Diagnosis dan Tatalaksana Preeklampsia (pp. 1–48). Himpunan Kedokteran Feto Maternal.

Pramana, C., Peranawengrum, K. B., Juliani, V., Laras, C., Nyoman, N., Luxzi, H., Supinganto, A., Staryo, N. A., Nurhidayah, Ernawati, K., Putri, S., Hadi, I., & Respati, G. (2020). Maternal characteristics and perinatal outcomes in Women with severe preeclampsia. Systematic Reviews in Pharmacy, 11(11), 549–553. https://doi.org/10.31838/srp.2020.11.80

Putri, N. K., Laksono, A. D., & Rohmah, N. (2023). Predictors of national health insurance membership among the poor with different education levels in Indonesia. BMC Public Health, 23(1), 373. https://doi.org/10.1186/s12889-023-15292-9

Skytte, H. N., Christensen, J. J., Gunnes, N., Holven, K. B., Lekva, T., Henriksen, T., Michelsen, T. M., & Roland, M. C. P. (2023). Metabolic profiling of pregnancies complicated by preeclampsia: A longitudinal study. Acta Obstetricia et Gynecologica Scandinavica, 102(3), 334–343. https://doi.org/10.1111/aogs.14505

Suhaimi, D., Novri, D. A., Hamidy, Y., & Savira, M. (2022). Effectiveness of nifedipine, labetalol, and hydralazine as emergency antihypertension in severe preeclampsia. F1000Research, 11, 1287. https://doi.org/10.12688/f1000research.125944.1

Sukartini, T., Arifin, H., Kurniawati, Y., Pradipta, R. O., Nursalam, N., & Acob, J. R. U. (2021). Factors associated with national health insurance coverage in Indonesia. F1000Research, 10, 563. https://doi.org/10.12688/f1000research.53672.1

Sultana, M., Akhter, Q. S., Ahmad, R., & Akter, T. (2022). Evaluation of RBC count and haemoglobin concentration in newborn of mother with and without preeclampsia. Scholars Journal of Applied Medical Sciences, 10(12), 2124–2130. https://doi.org/10.36347/sjams.2022.v10i12.013

Tyas, B. D., Lestari, P., & Aldika Akbar, M. I. (2019). Maternal perinatal outcomes related to advanced maternal age in preeclampsia pregnant women. Journal of Family & Reproductive Health, 13(4), 191–200. https://doi.org/10.18502/jfrh.v13i4.2646

Untari, E. kartika, Agilina, A. R., & Susanti, R. (2018). Evaluasi rasionalitas penggunaan obat antihipertensi di Puskesmas Siantan Hilir Kota Pontianak Tahun 2015. Pharmaceutical Sciences and Research, 5(1). https://doi.org/10.7454/psr.v5i1.3870

Voto, L. S., & Zeitune, M. G. (2022). Preeclampsia. In Perinatology, 707–746. Springer International Publishing. https://doi.org/10.1007/978-3-030-83434-0_40

Wijaya, D., Rohmah, A. S., Syarifuddin, S., & Rahmadanita, F. F. (2023). A Rationality study of antihypertensive drugs usage in preeclampsia patients in the private hospital. Proceedings of International Pharmacy Ulul Albab Conference and Seminar (PLANAR), 3, 37. https://doi.org/10.18860/planar.v3i0.2470

Wulandari, R. D., Laksono, A. D., Mubasyiroh, R., Rachmalina, R., Ipa, M., & Rohmah, N. (2023). Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective? BMC Public Health, 23(1), 92. https://doi.org/10.1186/s12889-023-15017-y

Yana, A. U., Brata, C., & Irawati, S. (2023). Studi penggunaan antihipertensi pada pasien preeklampsia rawat jalan di Poliklinik Rumah Sakit Ibu dan Anak Surabaya. Jurnal Kesehatan, 14(2), 319–326. https://doi.org/10.26630/jk.v14i2.3893

Yin, J., Mei, Z., Shi, S., Du, P., & Qin, S. (2022). Nifedipine or amlodipine? The choice for hypertension during pregnancy: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 306(6), 1891–1900. https://doi.org/10.1007/s00404-022-06504-5

Downloads

Published

2025-03-21

Issue

Vol. 15 No. 1 (2025): Pharmaciana

Section

Clinical and Community Pharmacy

License

Copyright (c) 2025 Adila Awaludin, Ayu Rahmawati, Annisa Annisa, Gina Septiani Agustien

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with Pharmaciana agree to the following terms:

  1. Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal. 
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.