Renoprotective effects of renin–angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients

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; I2 = 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.

Protective Effects of Amlodipine Pretreatment on Contrast-Induced Acute Kidney Injury And Overall Survival In Hypertensive Patients

“…(Sepehr-Ara et al, 2010; Sepehr-Ara et al, 2011) A meta-analysis concluded that ACEI/ARB plus CCB (including amlodipine) is stronger than ACEI/ARB plus diuretics for maintaining renal function in hypertensive patients. (Cheng et al, 2016) The study by Russo et al found that the renal plasma flow and GFR were increased in the group receiving nifedipine prior to injection of CM (n=30). (Russo et al, 1990) However, some other studies have reported the opposite.…”

Efficacy and Safety of Sodium Tanshinone IIA Sulfonate Injection on Hypertensive Nephropathy: A Systematic Review and Meta-Analysis

“…Thus, in recent clinical guidelines, eGFR, calculated based on the SCr level and other parameters, is recommended for the estimation of renal function because of its sensitivity and high specificity for one-time measures of renal damage or dysfunction (Qaseem et al, 2013;Stevens and Levin, 2013). Previous studies have demonstrated that angiotensin converting enzyme inhibitors (ACEIs) and ARBs could maintain eGFR during the progress of hypertension (Cheng et al, 2016). Similar to other outcomes, we found that STS and ARB combination is more effective than ARB monotherapy in improving eGFR.…”