Abstract
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.
Highlights
Hypertension is a major contributor to mortality and cardiovascular disease in chronic kidney disease (CKD)
Renin-angiotensin-aldosterone system blockades and calcium channel blockers for chronic kidney disease contact information can be found in the Supporting Information file "S2 File."
The searches for relevant research articles that compared the effects of Calcium channel blocker (CCB) and two of renin angiotensin aldosterone system blockades (RAAS) blockades, ACEIs and angiotensin receptor blockers (ARBs), in patients with hypertension and CKD included the relative free-text and medical subject heading terms of chronic kidney disease, hypertension, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonist, renin angiotensin aldosterone system in Cochrane Library, PubMed and Embase on 9th November 2017 (S2 Table)
Summary
Hypertension is a major contributor to mortality and cardiovascular disease in chronic kidney disease (CKD). In the Eighth Joint National Committee (JNC 8) guidelines[1] and a large randomized controlled trial (RCT) that showed a clinically considerable reduction in cardiovascular events and mortality in the intensive BPlowering group[2]. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), two of renoprotective renin–angiotensin–aldosterone system (RAAS) blockades, are correlated with acute kidney injury in critically ill patients[3]. Calcium 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
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