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Am J Perinatol 2025; 42(10): 1281-1287
DOI: 10.1055/a-2486-8840
Original Article

Daily versus Twice Daily Nifedipine for Blood Pressure Control in Pregnancy and Postpartum

Jessica A. Peterson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Isabelle C. Band 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Kelly Wang
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Angela Bianco
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
› Author Affiliations
Funding None.
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Abstract

Objective

The objective of this study was to compare 60 mg daily (QD) extended released (XR) nifedipine to 30 mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum.

Study Design

This is a retrospective chart review conducted at the Mount Sinai Health System. Patients admitted from January 1, 2015, to April 30, 2021, diagnosed with a hypertensive disorder of pregnancy, who received nifedipine XR 30 mg BID or 60 mg QD for intrapartum or postpartum BP control were included. The primary outcome was the need for up-titration (i.e., the need for an increase in nifedipine dose or addition of another antihypertensive) after reaching one of the study doses (30 mg BID or 60 mg QD). Patients were excluded if they had preexisting renal disease or were already on oral antihypertensives. In a 1:1 ratio between single- and twice-daily dosing groups, the sample size needed to detect a 20% difference in up-titration rate to achieve 0.80 power is 97 patients per group, for a total of 194 patients. This is based on a Pearson chi-square test with a significance level of 0.05.

Results

A total of 237 patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the need for an increase in nifedipine dose or addition of another oral antihypertensive agent between those receiving 30 mg BID versus 60 mg QD (33.8 vs. 35.7%; adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.90 [0.50–1.60]; p = 0.71). There was no difference in the need for emergency hypertensive treatment after reaching the study dose (p = 0.19) or readmission for BP control between groups (p > 0.99).

Conclusion

These findings suggest that BID dosing does not confer better BP control in the antepartum or postpartum periods. Thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.

Key Points

  • Nifedipine metabolism may increase in pregnancy.

  • nifedipine 30 mg BID versus 60 mg QD were compared.

  • There was no difference in the need for additional medication.

  • There was no difference in the need for readmission.

  • Daily dosing may be preferable for convenience.

Keywords

nifedipine - hypertensive disorders of pregnancy - blood pressure - hypertension - twice daily dosing


Publication History

Received: 22 August 2024

Accepted: 25 November 2024

Accepted Manuscript online:
26 November 2024

Article published online:
24 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 222: Gestational hypertension and preeclampsia. Obstet Gynecol 2020; 135: e237-e260
    CrossrefPubMedSearch in Google Scholar
  • 2 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
    CrossrefPubMedSearch in Google Scholar
  • 3 Anderson GD, Carr DB. Effect of pregnancy on the pharmacokinetics of antihypertensive drugs. Clin Pharmacokinet 2009; 48 (03) 159-168
    CrossrefPubMedSearch in Google Scholar
  • 4 Fashe MM, Fallon JK, Miner TA, Tiley JB, Smith PC, Lee CR. Impact of pregnancy related hormones on drug metabolizing enzyme and transport protein concentrations in human hepatocytes. Front Pharmacol 2022; 13: 1004010
    CrossrefPubMedSearch in Google Scholar
  • 5 Whelton PK, Carey RM, Aronow WS. et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71 (06) e13-e115
    CrossrefPubMedSearch in Google Scholar
  • 6 van de Vusse D, Mian P, Schoenmakers S. et al. Pharmacokinetics of the most commonly used antihypertensive drugs throughout pregnancy methyldopa, labetalol, and nifedipine: a systematic review. Eur J Clin Pharmacol 2022; 78 (11) 1763-1776
    CrossrefPubMedSearch in Google Scholar
  • 7 Weeda ER, Coleman CI, McHorney CA, Crivera C, Schein JR, Sobieraj DM. Impact of once- or twice-daily dosing frequency on adherence to chronic cardiovascular disease medications: a meta-regression analysis. Int J Cardiol 2016; 216: 104-109
    CrossrefPubMedSearch in Google Scholar
  • 8 Henegar CE, Westreich DJ, Maskew M, Miller WC, Brookhart MA, Van Rie A. Effect of pregnancy and the postpartum period on adherence to antiretroviral therapy among HIV-infected women established on treatment. J Acquir Immune Defic Syndr 2015; 68 (04) 477-480
    CrossrefPubMedSearch in Google Scholar