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

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.

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

“…A recent article studied the 2019-nCoV genome sequence and predicted that the new coronavirus shared the ACE2 receptor of SARS-CoV , which is a critical enzyme in the renin-angiotensin system (RAS) (Huang et al, 2014;Zou et al, 2014). RAS plays important roles in maintaining blood pressure homeostasis (Forrester et al, 2018), and salt and fluid balance (Lin et al, 2017). ACE and ACE2 play different roles in RAS; ACE generates Angiotensin II, whereas ACE2 is a negative regulator of the system, decreasing Angiotensin II (Crackower et al 2002).…”

Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients

“…ACE cleaves angiotensin I to generate angiotensin II, whereas ACE2 converts angiotensin II into angiotensin (1–7) 11 – 13 . By counteracting the action of ACE, ACE2 plays a crucial role in maintaining blood-pressure homeostasis, fluid, and salt balance 14 , 15 . ACE inhibitor (ACEI) and angiotensin receptor blockers (ARB) are the most commonly prescribed antihypertensive medications 16 – 19 .…”

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

“…A recent article studied the 2019-nCoV genome sequence and predicted that the new coronavirus shared the ACE2 receptor of SARS-CoV (Xu et al, 2020), which is a critical enzyme in the renin-angiotensin system (RAS) (Huang et al, 2014;Zou et al, 2014). RAS plays important roles in maintaining blood pressure homeostasis (Forrester et al, 2018), and salt and fluid balance (Lin et al, 2017). ACE and ACE2 play different roles in RAS; ACE generates Angiotensin II, whereas ACE2 is a negative regulator of the system, decreasing Angiotensin II (Crackower et al 2002).…”