Abstract: FR-PO574

The Benefit of Combined Calcium Channel Blockers with Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on Renal Outcomes in Hypertensive Patients: A Meta-Analysis

Session Information

Category: Hypertension

  • 1106 Hypertension: Clinical and Translational - Secondary Causes

Authors

  • Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
  • Pongpanich, Punnaka, Chulalongkorn university, Bangkok, Thailand
  • Pitakpaiboonkul, Pasvich, Chulalongkron university, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
Background

The prevalence of hypertension and its associated complications are likely to grow as the population ages. In addition, control of the disease is far from adequate, only fifty percent of persons with hypertension have their blood pressure under control, which was defined as a level below 140/90 mmHg. Most people need more than one drug to achieve blood pressure target. However, several guidelines only focus on the first line treatment. We conducted a meta-analysis to explore the benefits of combined calcium channel blockers (CCBs) with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on renal outcomes in hypertensive patients.

Methods

A systematic literature search was conducted in MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov (until April 7, 2016) to identify randomized controlled trials comparing the benefits of combined CCBs with ACEIs or ARBs vs. other combinations on renal outcomes in hypertensive patients. Random-effect models were used to compute the weighted mean difference (WMD) for continuous variables.

Results

Sixty randomized controlled trials (48,913 patients) were identified. Although, the combined CCBs with ACEIs or ARBs did not have statistically significant difference on the WMD of systolic blood pressure and diastolic blood pressure (73 study arms) when compared with other combinations (0.25 mmHg; 95%CI -0.33, 0.84 mmHg, P=0.40 and 0.05 mmHg , 95%CI -0.36, 0.47 mmHg, P=0.80, respectively) , the benefits on renal outcomes including the decreasing of serum creatinine (22 study arms, 1,791 patients, -4.08 mmol/L ,95%CI -5.71, -2.45 mmol/L, P< 0.001) and improving of estimated glomerular filtration rate (15 study arms, 1,853 patients, 4.13 mL/min/1.73m2,95% CI 2.26, 6.00 mL/min/1.73m2, P< 0.001) were observed when compared with other combinations. The significant increase of serum potassium was also observed. (25 study arms, 2,505 patients, 0.13 mEq/L;95% CI 0.07, 0.19 mEq/L, P<0.001)

Conclusion

The combination of CCBs with ACEIs or ARBs have a benefit on renal function in hypertensive patients. Therefore, this combination should be considered whenever monotherapy does not achieve guideline target.