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High-dose calcium channel blocker (CCB) monotherapy vs combination therapy of standard-dose CCBs and angiotensin receptor blockers for hypertension: a meta-analysis

Journal of Human Hypertension volume 31, pages 7988 (2017) | Download Citation

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Abstract

In this study, we evaluated the efficacy and safety of high-dose calcium channel blocker (CCB) monotherapy and standard-dose CCBs combined with angiotensin receptor blockers (ARBs) for patients with hypertension. A comprehensive search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was performed in December 2015. Randomized controlled trials designed to identify the above goal were included. Thirteen trials including 2371 patients were identified. The standard-dose CCB/ARB combination resulted in a greater reduction of systolic blood pressure (WMD −2.52, 95% confidence interval (CI): −3.76 to −1.28) and diastolic blood pressure (weighted mean difference (WMD) −2.07, 95% CI: −3.73 to −0.42) compared to high-dose CCB monotherapy. The overall hypertension control rate for the CCB/ARB combination was higher than that for CCB monotherapy (relative risk (RR): 1.17, 95% CI: 1.08–1.26). Furthermore, the CCB/ARB combination treatment yielded significantly fewer overall adverse events (RR: 0.84, 95% CI: 0.74–0.95), oedema (RR: 0.31; 95% CI: 0.18–0.52) and rash (RR: 0.27, 95% CI: 0.08–0.96, P=0.04) than did CCB monotherapy. The standard-dose CCB/ARB combination is superior to high-dose CCB monotherapy for lowering blood pressure and reducing adverse events in hypertensive patients. Future research should focus on the cost-effectiveness and long-term effects of these two treatment strategies for patients with hypertension.

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Acknowledgements

The study was supported by the National Natural Science Foundation of China (no. 81273594), the National Science and Technology Major Projects for ‘Major New Drugs Innovation and Development’ (no. 2012ZX0903014001), the National Key Technology R&D Program (no. 2012BAI37B05), the Fundamental Research Funds of Central South University (no. 2015zzts122) and the Fundamental Research Funds for the Central Universities of Central South University (no. 2016zzts565).

Author information

Author notes

    • T He
    •  & X Liu

    These authors contributed equally to this work.

Affiliations

  1. Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China

    • T He
    • , X Liu
    • , X Y Liu
    • , Q Y Wu
    •  & H Yuan
  2. Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China

    • Y Li
    •  & H Yuan
  3. Department of Gerontology, The First Hospital of Beijing University, Beijing, People’s Republic of China

    • M L Liu

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The authors declare no conflict of interest.

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Correspondence to H Yuan.

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DOI

https://doi.org/10.1038/jhh.2016.46

Supplementary Information accompanies this paper on the Journal of Human Hypertension website (http://www.nature.com/jhh)