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Combination therapy of renin–angiotensin system inhibitors plus calcium channel blockers versus other two-drug combinations for hypertension: a systematic review and meta-analysis

Journal of Human Hypertension volume 31, pages 1–13 (2017)Cite this article

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Abstract

Many randomized clinical trials (RCTs) have investigated the efficacy and safety of renin–angiotensin system inhibitors (RASIs) plus calcium channel blockers (CCBs), compared with other two-drug combinations, but systematic assessment in this aspect is still lacking. We carried out the present meta-analysis of randomized controlled trials to evaluate the long-term effect and safety of RASIs plus CCBs. Literatures were searched in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials in September 2014. A fixed-effect model was used to estimate the pooled effect of trials identified. Thirty-four trials with 41 694 patients were included. Compared with RASIs plus diuretics, RASIs plus CCBs decreased total cardiovascular (CV) events (relative risk (RR) 0.82, 95% confidence interval (CI): 0.75, 0.91, adjusted RR (ARR) 1.7%) and withdrawals due to adverse effect (WDAE) (RR 0.87, 95% CI: 0.80, 0.94, ARR 1.3%). Compared with CCBs plus diuretics, RASIs plus CCBs decreased WDAE (RR 0.63, 95% CI: 0.45, 0.90, ARR 1.1%). Our meta-analysis indicates that RASIs plus CCBs provide a superior safety and prevention of CV events to RASIs plus diuretics, whereas this combination is also safer than CCBs plus diuretics. We also raise a new hypothesis. More high-quality RCTs focused on hard end points with CV, cerebrovascular and renal events are needed to confirm the hypothesis we have brought out.

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Acknowledgements

We would like to acknowledge the help provided by Yongfang Wang from literature retrieval teaching and research section in Fudan University. This work was funded by Shanghai Municipal Commission of Health and Family Planning, China.

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  1. Z Lu and Y Chen: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China

    Z Lu, Y Chen, L Li, G Wang, H Xue & W Tang

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  1. Z Lu
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  2. Y Chen
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Correspondence to W Tang.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Lu, Z., Chen, Y., Li, L. et al. Combination therapy of renin–angiotensin system inhibitors plus calcium channel blockers versus other two-drug combinations for hypertension: a systematic review and meta-analysis. J Hum Hypertens 31, 1–13 (2017). https://doi.org/10.1038/jhh.2015.125

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