Renoprotective Effect of the Combination of Renin-angiotensin System Inhibitor and Calcium Channel Blocker in Patients with Hypertension and Chronic Kidney Disease

作     者：Rong-Shuang Huang Yi-Ming Cheng Xiao-Xi Zeng Sehee Kim Ping Fu 

作者机构：Department of Internal Medicine Renal Division West China Hospital of Sichuan University Chengdu Sichuan 610041 China West China Biostatistics and Cost-Benefit Analysis Center West China Hospital of Sichuan University Chengdu Sichuan 610041 China Department of Biostatistics University of Michigan Ann Arbor Michigan 48109 USA 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2016年第129卷第5期

页      面：562-569页

核心收录：

学科分类：1006[医学-中西医结合] 1002[医学-临床医学] 100602[医学-中西医结合临床] 10[医学] 

主　　题：Calcium Channel Blocker Chronic Kidney Disease Hypertension Renin-angiotensin System Inhibitor Renoprotection Therapy 

摘      要：Background：Renin-angiotensin system inhibitor and calcium channel blocker （CCB） are widely used in controlling blood pressure （BP） in patients with chronic kidney disease （CKD）.We carried out a meta-analysis to compare the renoprotective effect of the combination of angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） and CCB （i.e.,ACEI/ARB ＋ CCB） with ACEI/ ARB monotherapy in patients with hypertension and ***：Publications were identified from PubMed,Embase,Medline,and Cochrane *** randomized controlled trials （RCTs） of BP lowering treatment for patients with hypertension and CKD were *** outcomes of end-stage renal disease （ESRD）,cardiovascular events,BP,urinary protein measures,estimated glomerular filtration rate （GFR）,and adverse events were ***：Based on seven RCTs with 628 patients,ACEI/ARB ＋ CCB did not show additional benefit for the incidence of ESRD （risk ratio [RR] =0.84;95% confidence interval [CI]：0.52-1.33） and cardiovascular events （RR =0.58;95% CI：0.21-1.63） significantly,compared with ACEI/ARB *** were no significant differences in change from baseline to the end points in diastolic BP （weighted mean difference [WMD] =-1.28 mmHg;95% CI：-3.18 to-0.62）,proteinuria （standard mean difference =-0.55;95% CI：-1.41 to-0.30）,GFR （WMD =-0.32 ml/min;95% CI：-1.53 to-0.89）,and occurrence of adverse events （RR =1.05;95% CI：0.72-1.53）.However,ACEI/ARB ＋ CCB showed a greater reduction in systolic BP （WMD =-4.46 mmHg;95% CI：-6.95 to-1.97）,compared with ACEI/ARB ***：ACEI/ARB ＋ CCB had no additional renoprotective benefit beyond than what could be achieved with ACEI/ARB monotherapy.