Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao, Hongjin; Li, Yan; Liu, Shan-Mei; Sun, Xiang-Guo; Hu, Yan; Cui, Lianqun; Wang, Aihong

doi:10.3109/0886022x.2016.1165065

Cited by 16 publications

(13 citation statements)

References 47 publications

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“…Another hypothesis is that the greater use of calcium channel blockers by hypertensive patients with MetS could have resulted in BP control, but not in avoiding early renal damage, in agreement with several studies. 17 Another point to be mentioned is that despite of the greater use of antidiabetic drugs by patients with MetS, HbA1c remained higher in this group. On the other hand, studies 18 have consistently shown that levels of HbA1c < 7% are associated with a reduced risk of structural and clinical manifestations of diabetic nephropathy in patients with diabetes type 1 and type 2.…”

Section: Discussionmentioning

confidence: 87%

Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects

Catharina

Modolo

Ritter

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundMetabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation.ObjectiveThe purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives.MethodsThis cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis. Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted.ResultsWe found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders.ConclusionsOur findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS-related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS.

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Section: Discussionmentioning

confidence: 87%

Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects

Catharina

Modolo

Ritter

et al. 2018

Arquivos Brasileiros De Cardiologia

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“…Because the present systematic review included a large number of RCTs, subgroup analysis, and modified statistical methods, it could provide stronger evidence than previous studies as well as previous meta-analyses[ 48 ]. The previous meta-analysis reviewed 530 citations and included 10 RCTs to derive the conclusion that RAAS blockade is superior to CCBs in terms of ESRD events but has a similar effect on mortality, as demonstrated by forest plots without subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

Effects of calcium channel blockers comparing to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with hypertension and chronic kidney disease stage 3 to 5 and dialysis: A systematic review and meta-analysis

Lin

et al. 2017

PLoS ONE

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BackgroundCalcium channel blocker (CCB) or two renin angiotensin aldosterone system blockades (RAAS), angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are major potent and prevalently used as initial antihypertensive agents for mild to moderate hypertension, but no uniform agreement as to which antihypertensive drugs should be given for initial therapy, especially among chronic kidney disease (CKD) patients.DesignA systematic review and meta-analysis comparing CCBs and the two RAAS blockades for hypertensive patients with CKD stage 3 to 5D. The inclusion criteria for this systematic review was RCT that compared the effects of CCBs and the two RAAS blockades in patients with hypertension and CKD. The exclusion criteria were (1) renal transplantation, (2) CKD stage 1 or 2, (3) combined therapy (data cannot be extracted separately). Outcomes were blood pressure change, mortality, heart failure, stroke or cerebrovascular events, and renal outcomes.Results21 randomized controlled trials randomized 9,492 patients with hypertensive and CKD into CCBs and the two RAAS blockades treatments. The evidence showed no significant differences in blood presser change, mortality, heart failure, stroke or cerebrovascular events, and renal outcomes between CCBs group and the two RAAS blockades group. The publication bias of pooled mean blood presser change that was detected by Egger’s test was non-significant.ConclusionsCCBs has similar effects on long term blood pressure, mortality, heart failure, stroke or cerebrovascular events, and renal function to RAAS blockades in patients CKD stage 3 to 5D and hypertension.

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“…Tidak ditemukan perbedaan bermakna pada kedua luaran klinis antara kelompok ARB dan CCB secara statistik. Hasil yang ditemukan pada penelitian didukung dengan hasil penelitian lain yang menyebutkan bahwa ARB dan CCB memiliki efek terapetik yang serupa untuk menurunkan tekanan darah pada pasien PGK (Lin et al, 2017;Zhao et al, 2016).…”

Section: Luaran Klinis Tekanan Darah Tak Terkontrol Dan Kejadian Kard...unclassified

Perbandingan Efektivitas Angiotensin Receptor Blocker (ARB) dengan Calcium Channel Blocker (CCB) Pada Pasien Penyakit Ginjal Kronis dengan Hemodialisis

Kinanti

2022

J. Pharm. Sci. Clin. Res.

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Prevalensi pasien Penyakit Ginjal Kronis (PGK) berbanding lurus dengan peningkatan kejadian hipertensi. Penatalaksanaan hipertensi yang tepat dan efektif dibutuhkan pada kondisi PGK dalam hal pengendalian tekanan darah maupun memperlambat kejadian penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas Angiotensin Receptor Blocker (ARB) terhadap Calcium Channel Blocker (CCB) pada pasien PGK. Penelitian observasional ini dilakukan di RS Bethesda Yogyakarta dan merupakan penelitian dengan rancangan kohort retrospektif pada pasien PGK dengan hemodialisis (HD) yang mendapatkan terapi hipertensi pada periode tahun 2014-2019. Penelitian ini melibatkan 50 pasien yang direkrut secara total population sampling. Kelompok penelitian terdiri dari kelompok pasien yang mendapatkan terapi. Luaran klinis yang diamati adalah kejadian tekanan darah terkontrol dan kejadian kardiovaskular dalam waktu 12 bulan sejak index date. Hubungan antara jenis terapi dengan luaran klinis dianalisis dengan Chi-square sedangkan analisis survival dilakukan dengan metode Kaplan-Meier kemudian dilanjutkan dengan Log Rank Test. Kelompok terapi ARB menunjukkan proporsi kejadian tekanan darah tak terkontrol dan kejadian kardiovaskular yang lebih rendah dibandingkan kelompok terapi CCB (64% vs 84%, p=0,107; 16% vs 24%, p=0,48). Mean survival time kejadian tekanan darah tak terkontrol maupun kejadian kardiovaskular kelompok ARB lebih lama dibandingkan kelompok CCB (HR=0,513; CI 95%=0,241-1,092; p=0,128; HR=0,401; CI 95%=0,081-1,987; p=0,495). Hasil penelitian ini menunjukkan kejadian luaran klinis maupun waktu kejadian luaran klinis tidak berbeda bermakna antara kedua kelompok terapi. Penelitian dengan jumlah sampel lebih banyak dan periode pengamatan lebih lama dibutuhkan untuk mengetahui luaran klinis lebih lanjut antara ARB dan CCB pada pasien PGK dengan hemodialisis.

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Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Cited by 16 publications

References 47 publications

Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects

Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects

Effects of calcium channel blockers comparing to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with hypertension and chronic kidney disease stage 3 to 5 and dialysis: A systematic review and meta-analysis

Perbandingan Efektivitas Angiotensin Receptor Blocker (ARB) dengan Calcium Channel Blocker (CCB) Pada Pasien Penyakit Ginjal Kronis dengan Hemodialisis

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