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Meta-Analysis
. 2016 Jul;95(28):e4167.
doi: 10.1097/MD.0000000000004167.

Renoprotective effects of renin-angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients: A PRISMA-compliant meta-analysis

Yiming Cheng  1 , Rongshuang Huang, Sehee Kim, Yuliang Zhao, Yi Li, Ping Fu
Affiliations
Meta-Analysis

Renoprotective effects of renin-angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients: A PRISMA-compliant meta-analysis

Yiming Cheng et al. Medicine (Baltimore). 2016 Jul.

Abstract

Objectives: To conduct a meta-analysis of studies comparing the renoprotective effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) combined with either calcium channel blocker (CCB) or diuretic, but not both, in hypertensive patients.

Data sources: Pubmed, Embase, Medline, and Cochrane databases were searched to identify randomized controlled trials (RCTs) of blood pressure lowering treatments in patients with hypertension.

Study selection: RCTs comparing the renoprotective effects of ACEI/ARB plus CCB with ACEI/ARB plus diuretic in hypertensive patients, with at least one of the following reported outcomes: urinary protein, estimated glomerular filtration rate/creatinine clearance (eGFR/CrCl), or serum creatinine.

Results: Based on 14 RCTs with 18,125 patients, statistically significant benefits were found in ACEI/ARB plus CCB for maintaining eGFR/CrCl (standardized mean difference [SMD] = 0.36; 95% confidence interval [CI]: 0.20-0.53; P < 0.001), serum creatinine reduction (mean difference [MD] = -0.05 mg/dL; 95% CI: -0.07 to -0.03; P < 0.001). However, no statistical differences were found between the 2 therapeutic strategies in terms of urinary protein (MD = 7.48%; 95% CI: -6.13% to 21.08%; P = 0.28; I = 92%).

Conclusions: This meta-analysis concluded that ACEI/ARB plus CCB have a stronger effect on the maintenance of renal function in patients with hypertension than ACEI/ARB plus diuretic.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram for the study selection.
Figure 2
Figure 2
Comparison of ACEI/ARB plus CCB therapy with ACEI/ARB plus diuretic therapy for the changes of eGFR/CrCl. ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker, CCB = calcium channel blocker, CrCl = creatinine clearance, eGFR = estimated glomerular filtration rate.
Figure 3
Figure 3
Comparison of ACEI/ARB plus CCB therapy with ACEI/ARB plus diuretic therapy for the changes of serum creatinine. ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker, CCB = calcium channel blocker.
Figure 4
Figure 4
Comparison of ACEI/ARB plus CCB therapy with ACEI/ARB plus diuretic therapy for the changes of urinary protein related items. ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker, CCB = calcium channel blocker.
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