Effectiveness analysis of single and combined antihypertensive in coronary heart disease patients at Madiun Hospital, East Java

  • Yanuar As'hari Cahyaningrum STIKES Bhakti Husada Mulia Madiun
  • Laela Febriana Pharmacy Study Program, STIKES Bhakti Husada Mulia, Madiun, East Java 63139, Indonesia
  • R.F.X. Premihadi Putra Pharmacy Study Program, STIKES Bhakti Husada Mulia, Madiun, East Java 63139, Indonesia

Abstract

Background: Coronary heart disease (CHD) patients frequently require antihypertensive therapy to achieve optimal blood pressure control and reduce cardiovascular complications. The comparative effectiveness of monotherapy versus combination antihypertensive regimens remains an important clinical consideration.


Objective: To evaluate the effectiveness of monotherapy and combination antihypertensive treatments in achieving target blood pressure control among hospitalized CHD patients.


Methods: This retrospective analysis examined medical records of 139 CHD patients hospitalized between April and June 2021 at a regional hospital in Madiun, East Java. Treatment effectiveness was defined as achieving blood pressure targets below 140/90 mmHg. Independent Sample T-tests compared treatment outcomes between groups.


Results: Among 139 patients, 46 received monotherapy and 93 received combination therapy. Monotherapy effectiveness ranged from 80.0% to 88.8%, with calcium channel blockers achieving the highest success rate. Combination therapy demonstrated effectiveness rates between 76.9% and 91.8%, with angiotensin receptor blocker plus calcium channel blocker combinations showing optimal performance. Statistical analysis revealed significant differences in systolic blood pressure reduction between approaches (p=0.000), while diastolic outcomes showed no significant difference (p=0.632).


Conclusion: Both treatment approaches demonstrate substantial effectiveness, with combination therapy providing particular advantages for systolic blood pressure management in coronary heart disease patients.

References

1. Bertalina B. Relationship between Sodium Intake, Lifestyle, and Genetic Factors with Blood Pressure in Patients with Coronary Heart Disease. J Health. 2017;8(2).
2. World Health Organization. A Global Brief on Hypertension: Sillent Killer, Global Public Health Crisis. Switzerland: WHO Press; 2016.
3. Ministry of Health of the Republic of Indonesia. RISKESDAS Main Results 2018. Agency for Health Research and Development; 2018.
4. James PA, Suzanne O, Barry LC, William CC, Cheryl DH, Joel H, et al. Evidence-Based Guideline For The Management Of High Blood Pressure In Adults. JAMA. 2014;311(5). https://doi.org/10.1001/jama.2013.284429
5. Ghani L, Made DS, Harli N. Dominant Risk Factors of Coronary Heart Disease in Indonesia. Health Res Bull. 2016;44(3).

6. Khairiyah U, Muhammad AY, Nera UP. Patterns of Antihypertensive Drug Use in Hypertensive Patients in Hospital Outpatient Installations. J Syifar Sci Clin Res. 2022;4(3).
7. Nurhidayah, Elly W, Hasyim K. Analisis Kombinasi Penggunaan Obat Pada Pasien Jantung Koroner Di Rumah Sakit Universitas Hasanuddin Makassar. Maj Farm Farmakol. 2022;26(1).
8. Taroreh GN, Deby M, Gayari C. Evaluasi Penggunaan Obat Pada Pasien Dengan Penyakit Jantung Koroner Di Instalasi Rawat Inap RSUP Prof. DR.R.D. Kandou Manado. Pharmacon J Ilmiah Farmasi. 2017;6(4). https://doi.org/10.35790/eg.4.2.2016.14222
9. Auliafendri N, Darmiyani. Evaluasi Interaksi Obat Jantung Koroner Pada Pasien Rawat Inap Di Rumah Sakit Umum Imelda Pekerja Indonesia Medan. JIFI. 2022;5(20). https://doi.org/10.52943/jifarmasi.v5i2.775
10. Alomar MJ. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharm J. 2014;22(2):83-94. https://doi.org/10.1016/j.jsps.2013.02.003
11. Mekonnen AB, McLachlan AJ, Brien JA. Effectiveness of clinical pharmacy services: A systematic review and meta-analysis of randomized controlled trials. J Eval Clin Pract. 2018;24(3):603-12. https://doi.org/10.1111/jep.12941
12. Moreau KL, Hildreth KL, Meditz AL, Deane KD, Kohrt WM. Endothelial function is impaired across the stages of the menopause transition in healthy women. J Clin Endocrinol Metab. 2012 Dec;97(12):4692-700. https://doi.org/10.1210/jc.2012-2244
13. Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020 Jun 21;41(24):2313-30. https://doi.org/10.1093/eurheartj/ehz962
14. Zaman MA, Awais N, Satnarine T, Ahmed A, Haq A, Patel D, et al. Comparing Triple Combination Drug Therapy and Traditional Monotherapy for Better Survival in Patients With High-Risk Hypertension: A Systematic Review. Cureus. 2023 Jul 5;15(7):e41398. https://doi.org/10.7759/cureus.41398
15. Abernethy DR. Pharmacokinetics and pharmacodynamics of amlodipine. Cardiology. 1992;80 Suppl 1:31-6. https://doi.org/10.1159/000175050

16. Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, et al. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015 Jun;9(6):453-98. https://doi.org/10.1016/j.jash.2015.03.002
17. Bakris GL. Combined therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker. J Clin Hypertens (Greenwich). 2008 Jan;10(1 Suppl 1):27-32. https://doi.org/10.1111/j.1524-6175.2007.08029.x
18. Salam A, Raju K, Emily A, Xia W, Shariful I, Sandeep PK, et al. Efficacy and Safety Of Dual Combination Therapy Of Blood Pressure-Lowering Drugs as Initial Treatment For Hypertension: A Systematic Review and Meta-Analysis Of Randomized Controlled Trials. J Hypertens. 2019;32(9). https://doi.org/10.1097/HJH.0000000000002096
Published
2025-07-30
How to Cite
CAHYANINGRUM, Yanuar As'hari; FEBRIANA, Laela; PUTRA, R.F.X. Premihadi. Effectiveness analysis of single and combined antihypertensive in coronary heart disease patients at Madiun Hospital, East Java. Acta Pharmaciae Indonesia : Acta Pharm Indo, [S.l.], v. 12, n. 2, p. 13712, july 2025. ISSN 2621-4520. Available at: <https://jos.unsoed.ac.id/index.php/api/article/view/13712>. Date accessed: 19 aug. 2025. doi: https://doi.org/10.20884/1.api.2024.12.2.13712.