Distress associated with side effects of calcium channel blockers among a cohort of newly diagnosed with hypertension

Abstract

Antihypertensive therapy with calcium channel blockers (CCBs) is reported to be frequently associated with varying levels of distress due  to their side effects. The severity of distress may result in patients intentionally interrupting or withdrawing from therapy. In clinical settings, distress from side effects of drug(s) are sometimes left unreported, overlooked or poorly resolved by clinicians. The aim of this  study was to assess distress due to side effects of commonly prescribed CCB-based antihypertensive therapies.This was a prospective  observational study among patients newly diagnosed with primary hypertension being treated with either CCB monotherapies or  combination regimens as initial therapy. A total of 180 patients enrolled completed the eight week study and their data used in final  analysis. The subjects were allocated into six treatment groups of 30 each and given either amlodipine 10mg, nifedipine 20mg,  bendrofluthiazide (monotherapies) or their combinations with bendrofluthiazide 5mg or Lisinopril 5mg (dual therapies). The level of  distress before and after initiation of therapy was compared using Students t test and P values ≤ 0.05 was considered statistically  significant. Patients on dual therapies reported more side effects compared to monotherapies. The most commonly reported side effects  included loss of libido (38% - 47%), pitting edema (28% - 35%), headache (26% - 36%), muscle cramps (9% - 18%) and fatigue (17% - 30%).  Distress score of monotherapies (14.9) and dual therapies (15.3) was considered mild (< 25 threshold). There was significant reduction in  distress with bowel upset (P = 0.001), insomnia (P = < 0.001), pain (P = 0.001), breathing difficulties (P = 0.009) and concentration for BDF  containing regimen (P = 0.001). Distress among Lisinopril containing regimens involved appetite (P = 0.003), pain (P = 0.002) and fatigue  (P = 0.003). Overall, distress due to side effects was mild for all the antihypertensive drug(s).