Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria

Kohlmann, Osvaldo; Roca-Cusachs, A.; Laurent, Stéphane; Schmieder, Roland E.; Wenzel, René R.; Fogari, Roberto

doi:10.1007/s12325-009-0015-8

Cited by 12 publications

(5 citation statements)

References 36 publications

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“…Extremely wide credible intervals were noted for the treatments of ARB plus calcium channel blocker, ARB plus diuretic, and ACE inhibitor plus ARB, indicating great uncertainty in the estimation of treatment effect owing to small patient numbers and rare death events among those treatment arms. Sensitivity analyses showed robust results (see supplementary table E) since the rank ordering and statistical significance remained the same after omitting studies comparing with either ARB plus calcium channel blocker,27 ARB plus diuretic,28 or ACE inhibitor plus ARB 29. The combination therapy of ACE inhibitor plus calcium channel blocker showed the highest probability of being at the best ranking position, whereas the sensitivity analysis showed that omitting such a treatment arm did not impact on the ranking order and statistical significance of the remaining treatments (see supplementary table E).…”

Section: Resultsmentioning

confidence: 95%

Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis

Huang

Lin

et al. 2013

BMJ

201

126

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Objective To assess the effects of different classes of antihypertensive treatments, including monotherapy and combination therapy, on survival and major renal outcomes in patients with diabetes.Design Systematic review and bayesian network meta-analysis of randomised clinical trials.Data sources Electronic literature search of PubMed, Medline, Scopus, and the Cochrane Library for studies published up to December 2011. Study selectionRandomised clinical trials of antihypertensive therapy (angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), α blockers, β blockers, calcium channel blockers, diuretics, and their combinations) in patients with diabetes with a follow-up of at least 12 months, reporting all cause mortality, requirement for dialysis, or doubling of serum creatinine levels. Data extractionBayesian network meta-analysis combined direct and indirect evidence to estimate the relative effects between treatments as well as the probabilities of ranking for treatments based on their protective effects.Results 63 trials with 36 917 participants were identified, including 2400 deaths, 766 patients who required dialysis, and 1099 patients whose serum creatinine level had doubled. Compared with placebo, only ACE inhibitors significantly reduced the doubling of serum creatinine levels (odds ratio 0.58, 95% credible interval 0.32 to 0.90), and only β blockers showed a significant difference in mortality (odds ratio 7.13, 95% credible interval 1.37 to 41.39). Comparisons among all treatments showed no statistical significance in the outcome of dialysis. Although the beneficial effects of ACE inhibitors compared with ARBs did not reach statistical significance, ACE inhibitors consistently showed higher probabilities of being in the superior ranking positions among all three outcomes. Although the protective effect of an ACE inhibitor plus calcium channel blocker compared with placebo was not statistically significant, the treatment ranking identified this combination therapy to have the greatest probability (73.9%) for being the best treatment on reducing mortality, followed by ACE inhibitor plus diuretic (12.5%), ACE inhibitors (2.0%), calcium channel blockers (1.2%), and ARBs (0.4%).Conclusions Our analyses show the renoprotective effects and superiority of using ACE inhibitors in patients with diabetes, and available evidence is not able to show a better effect for ARBs compared with ACE inhibitors. Considering the cost of drugs, our findings support the use of ACE inhibitors as the first line antihypertensive agent in patients with diabetes. Calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone.

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Section: Resultsmentioning

confidence: 95%

Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis

Huang

Lin

et al. 2013

BMJ

201

126

View full text Add to dashboard Cite

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“…Among them, 8 RCTs recruited Asian subjects only, [ 13 – 15 , 18 , 20 , 21 , 23 , 24 ] while the other 6 RCTs were conducted in either mixed-race or unmentioned-race populations. Six RCTs compared the 2 combined treatments in 1001 patients with diabetes mellitus, [ 13 , 14 , 16 , 17 , 22 , 25 ] and 3 RCTs compared treatments in 1079 CKD patients. [ 19 , 23 , 24 ] Regarding the sample size, ACCOMPLISH (11,506 patients) and COLM (5141 patients) were the 2 largest RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…To assess renoprotective effects, 2 studies used 24-hour urinary albumin, [ 16 , 17 ] 3 studies used urinary ACR, [ 15 , 19 , 25 ] and 3 studies used UAE. [ 13 , 22 , 23 ] After integrating the outcomes of 24-hour urinary albumin, urinary ACR, and UAE, the meta-analysis showed that ACEI/ARB plus diuretic resulted in a 7.48% larger decline in the pooled urinary outcome, although the decline was not statistically significant (MD = 7.48%; 95% CI: −6.13% to 21.08%; P = 0.28; I 2 = 92%; Fig. 4 ).…”

Section: Resultsmentioning

confidence: 99%

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

Cheng

Huang²,

Kim³

et al. 2016

Medicine

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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.

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“…In other study performed in obese hypertensive patients, the delapril/manidipine combination but not the olmesartan/hydrochlorothiazide combination significantly decreased insulin resistance and plasma fibrinogen levels, despite similar BP lowering efficacy [ 94 ]. In another study performed in hypertensive patients with type 2 diabetes and microalbuminuria, whereas BP was reduced to a similar extent by both treatments after one year of follow-up, there was a trend for a reduction of blood glucose concentration from baseline with manidipine/delapril (mean change −0.2 mmol/L, p =0.064), but not with the losartan/hydrochlorothiazide combination [ 95 ].…”

Section: Manidipine: Beneficial Effects Beyond Blood Pressure Controlmentioning

confidence: 99%

Manidipine: an antihypertensive drug with positive effects on metabolic parameters and adrenergic tone in patients with diabetes

Saiz-Satjes

Martínez-Martín

2018

DIC

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Antihypertensive treatment of patients with diabetes should include those drugs with a positive effect on metabolic parameters. Most patients with diabetes require at least two antihypertensive agents. Combining a dihydropyridine calcium channel blocker with a renin-angiotensin-aldosterone system inhibitor is a rational approach. However, not all dihydropyridines are equal with respect to their effects on metabolic parameters. Thus, manidipine exerts a positive effect on insulin resistance. However, this effect has not been observed with amlodipine. On the other hand, the excessive activation of sympathetic nervous system has been related with an increase of insulin resistance, pulse pressure, and ankle edema rates. Compared with amlodipine, manidipine activates sympathetic nervous system to a lesser extent. As a result, treatment with manidipine represents a good option in hypertensive patients with diabetes.

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Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria

Abstract: A fixed-dose manidipine/delapril combination represents a useful addition to the treatment options available to control hypertension complicated by diabetes and microalbuminuria.

Cited by 12 publications

References 36 publications

Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis

Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis

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

Manidipine: an antihypertensive drug with positive effects on metabolic parameters and adrenergic tone in patients with diabetes

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