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. 2023 Apr 7;13(1):5727.
doi: 10.1038/s41598-023-32266-4.

Clinical outcomes of renin angiotensin system inhibitor-based dual antihypertensive regimens in chronic kidney disease: a network meta-analysis

Miseung Cho  1 , Chang-Young Choi  2 , Yeo Jin Choi  3   4   5 , Sandy Jeong Rhie  6   7
Affiliations

Clinical outcomes of renin angiotensin system inhibitor-based dual antihypertensive regimens in chronic kidney disease: a network meta-analysis

Miseung Cho et al. Sci Rep. .

Abstract

This study comprehensively investigated clinical outcomes associated with renin angiotensin system inhibitor-based dual antihypertensive regimens in non-dialysis chronic kidney disease (CKD) patients. Keyword searches of databases were performed per PRISMA-NMA guidelines. Frequentist network meta-analysis were conducted with 16 head-to-head randomized controlled trials. The effect sizes of dichotomous and continuous variables were estimated with odds ratio (OR) and standard mean differences (SMD), respectively. The protocol is registered in PROSPERO (CRD42022365927). Dual antihypertensive regimens with combination of angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) demonstrated substantially reduced odd of major cardiovascular disease (CVD) events over other regimens including angiotensin converting enzyme inhibitor (ACEI) monotherapy (OR 3.19) and ARB monotherapy (OR 2.64). Most significant reductions in systolic (SBP) and diastolic blood pressure (DBP) were observed with ARB-based CCB dual regimen over ACEI monotherapy (SMD 17.60 SBP and 9.40 for DBP), ACEI-based CCB regimen (SMD 12.90 for SBP and 9.90 for DBP), and ARB monotherapy (SMD 13.20 for SBP and 5.00 for DBP). However, insignificant differences were noticed for the odds of hyperkalemia, end stage renal disease progression, and all-cause mortality. ARB-based CCB regimen has the greatest benefits on BP reduction as well as major CVD risks in non-dialysis CKD patients.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA plot.
Figure 2
Figure 2
Network plot of included studies.
Figure 3
Figure 3
Quality Assessment of Included Studies and Outcomes.
Figure 4
Figure 4
Cardiovascular outcomes of antihypertensive interventions in CKD patients. (a) Major CVD events, (b) changes in SBP, and (c) changes in DBP.
Figure 5
Figure 5
Other clinical outcomes of antihypertensive interventions in CKD patients. (a) Hyperkalemia, (b) ESRD progression, and (c) all-cause mortality.
See this image and copyright information in PMC

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