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Review
. 2024 Dec 16;24(1):7.
doi: 10.1007/s40200-024-01538-9. eCollection 2025 Jun.

Azelnidipine and its role in decreasing urinary albumin creatinine ratio in people with type 2 diabetes and hypertension: a systematic review and meta-analysis

Jay Tewari  1 , Khalid Ahmad Qidwai  1 , Shubhajeet Roy  1 , Anadika Rana  1 , Satish Kumar  2 , Satyendra Kumar Sonkar  2 , Ajoy Tewari  3 , Virendra Atam  2
Affiliations
Review

Azelnidipine and its role in decreasing urinary albumin creatinine ratio in people with type 2 diabetes and hypertension: a systematic review and meta-analysis

Jay Tewari et al. J Diabetes Metab Disord. .

Abstract

Purpose: Type 2 diabetes mellitus and hypertension frequently coexist, increasing the risk of cardiovascular and renal complications. Urinary Albumin Creatinine Ratio (UACR) serves as a crucial predictor of these outcomes. While renin-angiotensin system inhibitors are often initial therapy, evidence suggests a potential role for Azelnidipine, a non-dihydropyridine calcium channel blocker, in reducing UACR, especially in cases of persistent proteinuria despite optimal therapy. However, conflicting results from existing studies necessitate a comprehensive systematic review and meta-analysis to clarify Azelnidipine's (AZL) efficacy in reducing UACR in people with type 2 diabetes mellitus and hypertension.

Methods: This meta-analysis, following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included randomized controlled trials (RCTs) published until January 15, 2024. Studies involving individuals with type 2 diabetes mellitus and hypertension were included, comparing AZL or AZL-containing regimens with other antihypertensive agents. The primary outcome was changes in UACR, with secondary outcomes including alterations in Glycated Hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and estimated glomerular filtration rate (eGFR).

Results: Six RCTs involving 731 participants were included. Meta-analysis revealed a significant reduction in UACR in the AZL group compared to controls (Mean Difference (MD) = -47.96; 95% Confidence Interval (CI): -79.56, -16.37; p = 0.003). AZL also significantly decreased HR (MD = -3.70; 95% CI: -6.66, -0.74; p = 0.01), while no significant changes were observed in HbA1c, SBP, DBP, or eGFR. Sensitivity analyses demonstrated the nuanced impacts of individual studies on results, highlighting the importance of careful interpretation.

Conclusion: This meta-analysis confirms AZL's efficacy in reducing UACR and HR in people with type 2 diabetes mellitus and hypertension.

Keywords: Azelnidipine; Calcium channel blockers; Hypertension; Type 2 diabetes mellitus; Urinary albumin creatinine ratio.

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Conflict of interest statement

Conflict of interestThe authors declared that they have no conflict of interest.

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