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. 2015 Dec;7(12):2243-52.
doi: 10.3978/j.issn.2072-1439.2015.12.39.

Meta-analysis of the efficacy and safety of adding an angiotensin receptor blocker (ARB) to a calcium channel blocker (CCB) following ineffective CCB monotherapy

Jin Ma  1 , Xiao-Yan Wang  1 , Zhi-De Hu  1 , Zhi-Rui Zhou  1 , Paul Schoenhagen  1 , Hao Wang  1
Affiliations

Meta-analysis of the efficacy and safety of adding an angiotensin receptor blocker (ARB) to a calcium channel blocker (CCB) following ineffective CCB monotherapy

Jin Ma et al. J Thorac Dis. 2015 Dec.

Abstract

Background: We conducted this meta-analysis to systematically review and analyze the clinical benefits of angiotensin receptor blocker (ARB) combined with calcium channel blocker (CCB) following ineffective CCB monotherapy.

Methods: PubMed was searched for articles published until August 2015. Randomized controlled trials (RCTs) evaluating the clinical benefits of ARB combined with CCB following ineffective CCB monotherapy were included. The primary efficacy endpoint of the studies was normal rate of blood pressure, the secondary efficacy endpoints were the response rate and change in blood pressure from baseline. The safety endpoint of the studies was incidence of adverse events. Differences are expressed as relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences (WMDs) with 95% CIs for continuous outcomes. Heterogeneity across studies was tested by using the I(2) statistic.

Results: Seven RCTs were included and had sample sizes ranging from 185 to 1,183 subjects (total: 3,909 subjects). The pooled analysis showed that the on-target rate of hypertension treatment was significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group (RR =1.59; 95% CI, 1.31-1.91; P<0.01). The response rate of systolic blood pressure (SBP) (RR =1.28; 95% CI, 1.04-1.58; P<0.01) and diastolic blood pressure (DBP) (RR =1.27; 95% CI, 1.12-1.44; P=0.04) were significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group. The change in SBP (RR =-3.56; 95% CI, -7.76-0.63; P=0.10) and DBP (RR =-3.03; 95% CI, -6.51-0.45; P=0.09) were higher in hypertensive patients receiving amlodipine + ARB but the difference did not reach statistical significance. ARB + amlodipine treatment carried a lower risk of adverse events relative to amlodipine monotherapy (RR =0.88; 95% CI, 0.80-0.96; P<0.01).

Conclusions: The results of our meta-analysis demonstrate that adding an ARB to CCB after initial ineffective CCB monotherapy, significantly improved blood pressure control and the percentage of on-target hypertension treatment with significantly reduced incidence of adverse events compared with continued CCB monotherapy.

Keywords: Hypertension; angiotensin receptor antagonists; calcium channel blockers (CCB); drug combinations; meta-analysis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Selection process for RCTs included in the meta-analysis.
Figure 2
Figure 2
Effects of ARB + CCB and CCB on BP normalization rate, based on a random-effects model. ARB, angiotensin receptor blocker; CCB, calcium channel blocker; BP, blood pressure.
Figure 3
Figure 3
Effects of ARB + CCB and CCB on BP response rate, based on a random-effects model. (A) SBP response rate; (B) DBP response rate. ARB, angiotensin receptor blocker; CCB, calcium channel blocker; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure.
Figure 4
Figure 4
Effects of ARB + CCB and CCB on change of BP from baseline, based on a random-effects model. (A) Delta SBP; (B) delta DBP. ARB, angiotensin receptor blocker; CCB, calcium channel blocker; BP, blood pressure; DBP, diastolic blood pressure.
Figure 5
Figure 5
Effects of ARB + CCB and CCB on adverse events, based on a random-effects model. ARB, angiotensin receptor blocker; CCB, calcium channel blockers.
See this image and copyright information in PMC

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