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Nifedipine or amlodipine? The choice for hypertension during pregnancy: a systematic review and meta-analysis

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Abstract

Background

There is a lack of sufficient evidence regarding efficacy and safety of amlodipine on treating hypertension during pregnancy.

Objective

To compare antihypertensive efficacy, pregnancy outcome and safety of amlodipine with nifedipine on hypertension during pregnancy.

Methods

A systematic search of PubMed, Embase, Cochrane Library, clinicaltrials.gov, Chinese National Knowledge Infrastructure, Wanfang Database and China Biology Medicine disc of randomized controlled trials (RCTs) up to April l5, 2021 was conducted on RCTs comparing amlodipine to nifedipine for the treatment of hypertension during pregnancy. Screening, data extraction, and quality assessment were done by two independent reviewers. To estimate relative effects from all available evidence, a meta-analysis was conducted.

Results

Seventeen RCTs were included. Amlodipine was found the efficacy is slightly superior to nifedipine on treating hypertension during pregnancy (RR 1.06, 95% CI 1.01 to 1.10) with a decreased risk for maternal side effects (RR 0.42, 95% CI 0.29 to 0.61). Subgroup analysis found amlodipine can get a better control on SBP (RR − 11.68, 95% CI − 17.98 to − 5.37) and DBP (RR − 7.44, 95% CI − 13.81 to − 1.06) compared with intermediate-/long-acting nifedipine. In addition, there was no difference between amlodipine and nifedipine on pregnancy outcomes including caesarean section, premature labour, placental abruption, FGR, fetal distress, neonatal asphyxia.

Conclusions

Given the results of this systematic review and meta-analysis, amlodipine can be effectively and safely used for hypertension during pregnancy.

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References

  1. Lale S et al (2014) Global causes of maternal death: a WHO systematic analysis[J]. Lancet Glob Health 2:e323–e333

    Article  Google Scholar 

  2. Abalos E, Duley L, Steyn DW et al (2018) Antihypertensive drug therapy for mild to moderate hypertension during pregnancy[J]. Cochrane Database Syst Rev 10:D2252

    Google Scholar 

  3. Magee LA, Abalos E, Von Dadelszen P et al (2011) How to manage hypertension in pregnancy effectively[J]. Br J Clin Pharmacol 72:394–401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. (2019) ACOG practice bulletin No. 203: chronic hypertension in pregnancy[J]. Obstet Gynecol 133(1):e26–e50

  5. Butalia S, Audibert F, Cote AM et al (2018) Hypertension Canada’s 2018 guidelines for the management of hypertension in pregnancy[J]. Can J Cardiol 34(5):526–531

    Article  PubMed  Google Scholar 

  6. Toal CB (2004) Formulation dependent pharmacokinetics-does the dosage form matter for nifedipine[J]? J Cardiovasc Pharmacol 44:82–86

    Article  CAS  PubMed  Google Scholar 

  7. (2019) ACOG Committee Opinion No. 767: emergent therapy for acute-onset, severe hypertensionduring pregnancy and the postpartum period[J]. Obstet Gynecol 133(2):e174–e180

  8. Shekhar S, Gupta N, Kirubakaran R et al (2016) Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis[J]. BJOG 123(1):40–47

    Article  CAS  PubMed  Google Scholar 

  9. Fares H, DiNicolantonio JJ, O’Keefe JH et al (2016) Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes[J]. Open Heart 3(2):e473

    Article  Google Scholar 

  10. Morgan JL, Kogutt BK, Meek C et al (2018) Pharmacokinetics of amlodipine besylate at delivery and during lactation[J]. Pregnancy Hypertens 11:77–80

    Article  PubMed  PubMed Central  Google Scholar 

  11. Xiaoli C (2015) Clinical study on amlodipine medication treatment of gestational hypertension[J]. China Continu Med Educ 7(13):171–172

    Google Scholar 

  12. Yifeng G, Miaoni Li (2013) Therapeutic effect analysis of amlodipine in 40 cases of pregnancy complicated with hypertension[J]. Inter Med 8(4):356–357

    Google Scholar 

  13. Bojin G (2015) Efficacy comparison between amlodipine and nifedipine in the treatment of pregnancy complicated with hypertension[J]. Cardiovasc Dis Prev 4(8):28–29

    Google Scholar 

  14. Hu S, Zhang H, Luan J, Li X (2015) Efficacy comparison between amlodipine and nifedipine in the treatment of pregnancy complicated with hypertension[J]. Chin Foreign Womens Health Res 7:165

    Google Scholar 

  15. Jin Ju (2018) Clinical effect of amlodipine in the treatment of pregnant patients with hypertension[J]. Health 12(8):82–83

    Google Scholar 

  16. Guiying Li, Hongxia S (2016) Contrastive observation of amlodipine and nibendipine in the treatment of pregnancy complicated with hypertension[J]. Chin Foreign Womens Health Res 23:166–172

    Google Scholar 

  17. Wei L (2015) Clinical effect of amlodipine in the treatment of pregnancy complicated with hypertension[J]. J Prev Treat Cardiovasc Dis 8:26–27

    Google Scholar 

  18. Zizhen R (2014) Clinical effect analysis of amlodipine in the treatment of pregnant patients with hypertension[J]. Jilin Med Sci 35(27):6006–6007

    Google Scholar 

  19. Wang F (2016) Comparison of curative effect between amlodipine and nifedipine on pregnancy complicated with hypertension[J]. Cardiovasc Dis J Integr Tradi Chin Western Med 4(11):63–66

    Google Scholar 

  20. Hong W (2018) Amlodipine and nifedipine in the treatment of hypertension complicated by pregnancy[J]. China & Foreign Med Treat 37(19):107–108

    Google Scholar 

  21. Zifen W, Haixiang S, Lili G (1997) Clinical analysis of amlodipine in the treatment of hypertension during pregnancy[J]. J Linyi Med Coll 4:291–293

    Google Scholar 

  22. Hui X (2016) Effect analysis of amlodipine in the treatment of pregnant patients with hypertension[J]. Cardiovasc Dis J Integr Tradi Chin Western Med 4(25):72–74

    Google Scholar 

  23. Yunxia X, Huiping Z (2017) Clinical effect of amlodipine and nifedipine in the treatment of pregnancy hypertension[J]. Ningxia Med J 39(4):357–359

    Google Scholar 

  24. Yuan Y (2016) Comparison of clinical effects between amlodipine and nifedipine in the treatment of 48 cases of pregnancy complicated with hypertension[J]. World Latest Med Infor 16(41):96–99

    Google Scholar 

  25. Junsu Z (2018) Effect of amlodipine and nifedipine on pregnancy complicated with hypertension[J]. Cardiovasc Dis J Integr Tradi Chin Western Med 6(35):125–126

    Google Scholar 

  26. Zhang Y (2019) Clinical analysis of amlodipine in the treatment of pregnancy complicated with hypertension[J]. Electronic J Pract Gynecol Endocrinol 6(16):119–120

    CAS  Google Scholar 

  27. Li Z (2017) Efficacy comparison between amlodipine and nifedipine in the treatment of pregnancycomplicated with hypertension[J]. World Clin Med 11(21):100

    Google Scholar 

  28. Weber-Schoendorfer C, Hannemann D, Meister R et al (2008) The safety of calcium channel blockers during pregnancy: a prospective, multicenter, observational study[J]. Reprod Toxicol 26(1):24–30

    Article  CAS  PubMed  Google Scholar 

  29. Salama M, Rezk M, Gaber W et al (2019) Methyldopa versus nifedipine or no medication for treatment of chronic hypertension during pregnancy: a multicenter randomized clinical trial[J]. Pregnancy Hypertens 17:54–58

    Article  PubMed  Google Scholar 

  30. Webster LM, Myers JE, Nelson-Piercy C et al (2017) Labetalol versus nifedipine as antihypertensivetreatment for chronic hypertension in pregnancy: a randomized controlled trial[J]. Hypertension 70(5):915–922

    Article  CAS  PubMed  Google Scholar 

  31. Huang QF, Sheng CS, Li Y et al (2019) A randomized controlled trial on the blood pressure-lowering effect of amlodipine and nifedipine-GITS in sustained hypertension[J]. J Clin Hypertens (Greenwich) 21(5):648–657

    Article  CAS  Google Scholar 

  32. Malachias MV, Figueiredo CE, Sass N et al (2016) 7th Brazilian guideline of arterial hypertension: chapter 9 – arterial hypertension in pregnancy. Arq Bras Cardiol 107(3 Suppl 3):49–52

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Magee LA, Brown MA, Hall DR et al (2021) The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice[J]. Pregnancy Hypertens 27:148–169

    Article  PubMed  Google Scholar 

  34. Cifkova R, Johnson MR, Kahan T et al (2020) Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension[J]. Eur Heart J Cardiovasc Pharmacother 6(6):384–393

    Article  PubMed  Google Scholar 

  35. (2019) Hypertension in pregnancy: diagnosis and management. National Institute for Health and Care Excellence (NICE), London

  36. Mito A, Murashima A, Wada Y et al (2019) Safety of Amlodipine in Early Pregnancy[J]. J Am Heart Assoc 8(15):e12093

    Article  Google Scholar 

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Funding

This study was supported by Guangdong Medical Science and Technology Research Foundation (A2020161).

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Authors and Affiliations

  1. Department of Pharmacy, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, People’s Republic of China

    Jinjin Yin, Zhengrong Mei & Shengying Shi

  2. Department of Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, People’s Republic of China

    Peili Du

  3. Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, People’s Republic of China

    Shumin Qin

Authors
  1. Jinjin Yin
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Contributions

YJ, QS wrote the protocol. YJ performed the search. YJ and QS independently selected eligible studies and extracted data. Differences of opinion were registered and resolved by consensus with DP, SS. YJ and QS performed the meta-analyses. YJ, MZ, DP, SS, QS participated in the interpretation of the data and writing of the review.

Corresponding author

Correspondence to Shumin Qin.

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Conflict of interest

None declared. Completed disclosure of interests form available to view online as supporting information.

Ethical approval

Ethical approval was not needed for this meta-analysis.

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Yin, J., Mei, Z., Shi, S. et al. Nifedipine or amlodipine? The choice for hypertension during pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet 306, 1891–1900 (2022). https://doi.org/10.1007/s00404-022-06504-5

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  • DOI: https://doi.org/10.1007/s00404-022-06504-5

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