Amlodipine-Induced Pedal Edema and Its Relation to Other Variables in Patients at a Tertiary Level Hospital of Kathmandu, Nepal

Sitaram Khadka; Rinku Joshi; Dhan Bahadur Shrestha; Drishti Shah; Niroj Bhandari; Magina Maharjan; Serene Sthapit

doi:10.1177/8755122518809005

Amlodipine-Induced Pedal Edema and Its Relation to Other Variables in Patients at a Tertiary Level Hospital of Kathmandu, Nepal

J Pharm Technol. 2019 Apr;35(2):51-55. doi: 10.1177/8755122518809005. Epub 2018 Oct 31.

Authors

Sitaram Khadka^{1

2}, Rinku Joshi^{1

2}, Dhan Bahadur Shrestha^{1

2}, Drishti Shah^{1

2}, Niroj Bhandari³, Magina Maharjan⁴, Serene Sthapit⁵

Affiliations

¹ Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
² Shree Birendra Hospital, Chhauni, Kathmandu, Nepal.
³ Kathmandu University, Dhulikhel, Kathmandu, Nepal.
⁴ Grande International Hospital, Kathmandu, Nepal.
⁵ Green City Hospital, Kathmandu, Nepal.

Abstract

Background: Vasodilatory edema is a frequently encountered side effect among hypertensive patients using antihypertensive drugs. This dose-dependent adverse effect is seen more commonly with amlodipine, so low-dose combination therapy is often used and preferred in practice. Pedal edema following use of amlodipine is scarcely studied in Nepalese population so far. Objectives: To find out the prevalence of amlodipine-associated pedal edema and its relation with other variables among patients presenting to a tertiary care center of Kathmandu, Nepal. Methods: A prospective cross-sectional study was conducted among hypertensive patients using amlodipine in combination with or without other antihypertensive medications under regular follow-up in an outpatient department of internal medicine of Shree Birendra Hospital, Kathmandu, Nepal, during the 7-month period from September 2017 to March 2018. The prevalence of pedal edema and its relation with amlodipine dose, duration, and other factors were studied using χ² test and logistic regression using SPSS version 22. Results: A total of 505 patients were observed during the study period, with the mean age of the population being 61.5 ± 13.4 years. Among the cases studied, edema was present in 79 (15.6%) cases. Use of amlodipine longer than 5 years was 21.65 (confidence interval [CI] = 9.575-48.970, P ˂ .001) times more likely to exhibit pedal edema; similarly, there was 2.149 (CI = 1.209-3.820, P = .009) times higher risk of having pedal edema in hypertensive individuals with other comorbidities. Increasing the dose of amlodipine has increased the likelihood of having pedal edema, but it is not statistically significant (odds ratio = 2.804, CI = 0.423-18.584, P = .285). Conclusion and Relevance: Significant number of hypertensive patients using amlodipine developed pedal edema. Likelihood of vasodilatory edema increases with the presence of comorbidities, higher dose, along with longer duration of amlodipine use.

Keywords: Nepal; amlodipine; vasodilatory edema.