Adverse Drug Reactions Study of Antihypertensive Drugs in Primary Care Settings

Yeni Farida(1*), Kharimah Faizathus Tsalatsatun(2)

(1) Universitas Sebelas Maret, Surakarta, Jawa Tengah
(2) Universitas Sebelas Maret, Surakarta, Jawa Tengah
(*) Corresponding Author


Hypertension is one of the high-prevalence diseases in primary care. Failure to achieve the target of blood pressure is affected by non-compliance due to the antihypertensive adverse reactions. This study aims to determine adverse drug reaction (ADR) of antihypertensive drugs in primary care settings. A cross sectional study was conducted in “Sibela” Primary Care in Surakarta on March 2019. Investigators interviewed patients directly and observed supporting data from medical records. Hypertension patients with antihypertensive drugs at least for a month were eligible in this study.  Then, the data were analyzed by the Liverpool algorithm that interpreted in 4 scales: unlikely, possible, probable, and definite.  A total 70 subject were dominated by female (80%). Monotherapy of antihypertensive drugs prescribed to patient in primary care were amlodipine (80%) and captopril (10%). Nine events of ADR were found in hypertension patient. None ADR were doubtful. Possible ADR of amlodipine was drowsiness (5.4%), whereas probable ADR were nausea (3.4%), diuresis (1.8%), and abdominal pain (1.8 %). Definite ADR of captopril was dry mouth (14.3%) and probable ADR was abdominal pain (14.3%). Further investigation regarding the drowsiness, ADR of amlodipine, was needed.


antihypertensive drugs; Liverpool Algorithm; primary care; ADR

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  1. Indonesian Health Ministry. Basic Health Research. Jakarta; 2018.
  2. Widjaja FF, Santoso LA, Barus NRV, Pradana GA, Estetika C. Prehypertension and hypertension among young Indonesian adults at a primary health care in a rural area. Med J Indones. 2013;22(1):39-45.
  3. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: The NHANES III Linked Mortality Study. Sci Rep. 2018;8(1).
  4. Tedla YG, Bautista LE. Drug ADR Symptoms and Adherence to Antihypertensive Medication. Am J Hypertens. 2016;29(6):772-779.
  5. Paranoan R, Manggau MA, Kasim H, Djide MN, Lallo S, Djabir YY. Analisis Efektivitas Dan Efek Samping Penggunaan Antihipertensi Pada Pasien Gagal Ginjal Kronik Rawat Inap di RSUP Dr. Wahidin Sudirohusodo. Maj Farm dan Farmakol. 2019;23(1):13-15.
  6. Kristanti P. Efektifitas Dan Efek Samping Penggunaan Obat Antihipertensi Pada Pasien Hipertensi Di Puskesmas Kalirungkut Surabaya. Calyptra J Ilm Mhs Univ Surabaya. 2015;4(2). Accessed September 23, 2020.
  7. Gallagher RM, Kirkham JJ, Mason JR, et al. Development and inter-rater reliability of the Liverpool adverse drug reaction causality assessment tool. PLoS One. 2011;6(12).
  8. Bina D, Komunitas F, Klinik DAN, et al. Pharmaceutical care. 2006.
  9. Pinto E. Blood pressure and ageing. 2007:109-114. Accessed November 11, 2019.
  10. Iorga A, Cunningham CM, Moazeni S, Ruffenach G, Umar S, Eghbali M. The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ. 2017;8(1):33.
  11. Hegde SM, Solomon SD. Influence of Physical Activity on Hypertension and Cardiac Structure and Function. Curr Hypertens Rep. 2015;17(10).
  12. Ohishi M. Hypertension with diabetes mellitus: Physiology and pathology review-article. Hypertens Res. 2018;41(6):389-393.
  13. Taylor SH. Usefulness of amlodipine for angina pectoris. Am J Cardiol. 1994;73(3).
  14. Fares H, DiNicolantonio JJ, O’Keefe JH, Lavie CJ. Amlodipine in hypertension: A first-line agent with efficacy for improving blood pressure and patient outcomes. Open Hear. 2016;3(2):1-7.
  15. Turtle EJ, Dear JW, Webb DJ. A systematic review of the effect of paracetamol on blood pressure in hypertensive and non-hypertensive subjects. Br J Clin Pharmacol. 2013;75(6):1396-1405.
  16. Yunita EP, Zulkarnain BS, Aminuddin M. Aspirin Resistance in Coronary Artery Disease with Hypertensive Patients. Indones J Clin Pharm. 2015;4(1):28-38.
  17. Kour D, Tandon VR, B. K, Mahajan A, Parihar A, Smotra S. Aspirin Resistance. JK Sci. 2006;8(2):116-117.
  18. Fournier JP, Sommet A, Bourrel R, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: A population-based cohort study. Eur J Clin Pharmacol. 2012;68(11):1533-1540.
  19. Grossman E, Messerli FH. Drug-induced hypertension: An unappreciated cause of secondary hypertension. Am J Med. 2012;125(1):14-22.
  20. Rosenberg A, Agiro A, Gottlieb M, et al. Early trends among seven recommendations from the choosing wisely campaign. JAMA Intern Med. 2015;175(12):1913-1920.
  21. Bouck Z, Mecredy GC, Ivers NM, et al. Frequency and Associations of Prescription Nonsteroidal Anti-inflammatory Drug Use among Patients with a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease. JAMA Intern Med. 2018;178(11):1516-1525.
  22. Landefeld K, Gonzales H, Sander GE. Journal of Clinical Case Reports Hypertensive Crisis : The Causative Effects of Nonsteroidal Anti- Inflammatory Drugs. J Clin Case Reports. 2016;6(7):10-12.
  23. Milovanović B, Trifunović D, Milićević N, Vasić K, Krotin M. The significance of amlodipine on autonomic nervous system adjustment (ANSA Method): A new approach in the treatment of hypertension. Srp Arh Celok Lek. 2009;137(7-8):371-378.
  24. Hughes J, Lockhart J, Joyce A. Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain? Br J Clin Pharmacol. 2007;64(1):83-89.
  25. Fujita T, Ando K, Nishimura H, et al. Antiproteinuric effect of the calcium channel blocker cilnidipine added to renin-angiotensin inhibition in hypertensive patients with chronic renal disease. Kidney Int. 2007;72(12):1543-1549.
  26. Sanghavi, Someshwari, Rajanandh, Seenivasan. Amlodipine Induced Severe Pedal Edema: A Case Report from a Tertiary Care Hospital. J Pharmacovigil. 2017;5(5).
  27. Hall SA, Chiu GR, Kaufman DW, Wittert GA, Link CL, McKinlay JB. Commonly used antihypertensives and lower urinary tract symptoms: Results from the Boston Area Community Health (BACH) Survey. BJU Int. 2012;109(11):1676-1684.
  28. Galappatthy P, Waniganayake YC, Sabeer MIM, Wijethunga TJ, Galappatthy GKS, Ekanayaka RAI. Leg edema with (S)-amlodipine vs conventional amlodipine given in triple therapy for hypertension: A randomized double blind controlled clinical trial. BMC Cardiovasc Disord. 2016;16(1):1-10.
  29. Dicpinigaitis P V. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 SUPPL.):169S-173S.
  30. Tom B, Dendorfer A, De Vries R, Saxena PR, Danser AHJ. Bradykinin potentiation by ACE inhibitors: A matter of metabolism. Br J Pharmacol. 2002;137(2):276-284.
  31. Kumar R, Sharma R, Bairwa K, Roy KR, Kumar A, Baruwa A. Modern Development in ACE inhibitors. Der Pharm Lett. 2010;2(43):388-419.
  32. Lacy CF, Armstrong LL, Glodman MP, Lance LL. Drug Information Handbook. 17th Edition. Hudson: Lexi-Comp; 2009.
  33. Palmquist S, Mathews B. Isolated intestinal type angioedema due to ACE-inhibitor therapy. Clin Case Reports. 2017;5(5):707-710.
  34. Celbek G, Aydın Y, Ermiş F, Güngör A, Kutlucan A, Önder E. Rare Acute Pancreatitis Cases Due to Different Antihypertensive Drugs: Four Cases. Acta Medica Anatolia. 2014;3(X-X).


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