Effects of calcium channel blockers comparing to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with hypertension and chronic kidney disease stage 3 to 5 and dialysis: A systematic review and meta-analysis

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.

背景
钙通道阻滞剂（Calcium channel blocker, CCB）以及两种肾素-血管紧张素-醛固酮系统阻滞剂（renin angiotensin aldosterone system blockades, RAAS）——即血管紧张素转换酶抑制剂（angiotensin-converting enzyme inhibitors, ACEIs）与血管紧张素Ⅱ受体拮抗剂（angiotensin receptor blockers, ARBs）——是轻中度高血压患者初始降压治疗的主流强效常用药物，但目前针对初始降压方案的选择尚未达成统一共识，在慢性肾脏病（chronic kidney disease, CKD）患者群体中这一问题尤为突出。
研究设计
本研究为一项系统评价与荟萃分析，旨在对比CCB与两种RAAS阻滞剂用于3~5D期慢性肾脏病合并高血压患者的临床疗效。本系统评价的纳入标准为：对比CCB与两种RAAS阻滞剂在高血压合并CKD患者中治疗效果的随机对照试验（randomized controlled trial, RCT）。排除标准如下：（1）肾移植术后患者；（2）CKD 1期或2期患者；（3）接受联合药物治疗且无法单独提取相关数据的研究。本研究的结局指标包括血压变化、全因死亡率、心力衰竭、卒中或脑血管事件，以及肾脏相关结局。
研究结果
本研究共纳入21项随机对照试验，共计9492例高血压合并CKD患者，被随机分配至CCB治疗组与两种RAAS阻滞剂治疗组。分析结果显示，CCB组与两种RAAS阻滞剂组在血压变化、全因死亡率、心力衰竭、卒中或脑血管事件以及肾脏结局方面均无显著统计学差异。通过Egger检验检测合并后的血压变化指标的发表偏倚，结果无统计学意义。
研究结论
在3~5D期慢性肾脏病合并高血压患者中，CCB在长期血压控制、全因死亡率、心力衰竭、卒中或脑血管事件以及肾功能保护方面的疗效与RAAS阻滞剂相当。