The benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers combined with calcium channel blockers on metabolic, renal, and cardiovascular outcomes in hypertensive patients: a meta-analysis

Pongpanich, Punnaka; Pitakpaiboonkul, Pasvich; Takkavatakarn, Kullaya; Praditpornsilpa, Kearkiat; Eiam‐Ong, Somchai; Susantitaphong, Paweena

doi:10.1007/s11255-018-1991-x

Cited by 17 publications

(9 citation statements)

References 104 publications

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“…In a meta-analysis (n=48,913), RAS blockers plus CCBs compared with other antihypertensive combinations, were associated with a significant decrease in FPG by 2.3 mg/dL (p=0.03) and a significant net decrease in HbA1c of 0.20% (p<0.001) 82 .…”

Section: Arbs/ccbs Combinationmentioning

confidence: 99%

An overview of the effects of combination therapy with a renin-angiotensin system blocker plus a calcium channel blocker on glucose homeostasis in non-diabetic hypertensive patients

Liontos¹,

Biros²,

Liamis³

et al. 2022

JAPT

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Arterial hypertension (AH) is a major cardiovascular risk factor and often coexists with insulin resistance. Insulin resistance impairs glucose homeostasis and has been associated with the development of new-onset type 2 diabetes mellitus (T2D). Overactivity of renin-angiotensin system (RAS) mediated by angiotensin II adversely affects glucose homeostasis. The blockade of RAS with the use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) has been associated with beneficial effects on glucose metabolism. On the other hand, calcium channel blockers (CCBs) have been reported to exert a metabolic neutral effect. By contrast, the use of diuretics and beta-blockers has been shown to have an overall negative effect on glucose metabolism. Current ESH/ESC treatment guidelines recommend the use of fixed single-pill combinations of RAS blockers with either CCBs or thiazide/thiazide-like diuretics in hypertensive patients with grade 1 AH and high cardiovascular risk, or greater. Nonetheless, considering the patient’s medical history and comorbidities, antihypertensive treatment should be carefully tailored. To this, hypertensive patients at risk of developing new-onset T2D, with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), should be preferentially treated with either monotherapy or combined treatment using agents which do not affect or worsen glucose homeostasis.

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Section: Arbs/ccbs Combinationmentioning

confidence: 99%

An overview of the effects of combination therapy with a renin-angiotensin system blocker plus a calcium channel blocker on glucose homeostasis in non-diabetic hypertensive patients

Liontos¹,

Biros²,

Liamis³

et al. 2022

JAPT

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“…Так, при сравнении комбинации блокатора РААС с БКК и монотерапии БКК у пациентов с СД и АГ отмечается дополнительное снижение общей смертности на 5,2%, сердечно-сосудистой смертности на 0,7%, риск развития инфаркта миокарда -на 0,9% [24]. Данная комбинация снижала креатинин на 4,08 ммоль/л и повышала СКФ на 4,13 мл/мин/1,73 м 2 у пациентов с СД и ХБП [25].…”

Section: Arterial Hypertension In Diabetes Mellitusunclassified

The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus

Demidova

Kislyak

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Arterial hypertension (AH) is powerful and modifying factor of developing macrovascular and microvascular complications of diabetes. Patients with AH and diabetes belong to group with high and very high levels risk of developing cardiovascular complications and chronic kidney disease. The combination of type 2 diabetes mellitus and AH dramatically increases the risk of developing terminal stages of microvascular and macrovascular diabetic complications: blindness, end-stage chronic kidney disease, amputation of the lower extremities, myocardial infarction, cerebral stroke, worsens the patients prognosis and quality of life. There is ample evidence that blood pressure control in diabetic patients may be critical for improving long-term prognosis. This observation does not lose its relevance even with the emergence of new antidiabetic drugs with proven cardio- and nephroprotective effects. Modern clinical researchers and meta-analysis show the priority of combined antihypertensive therapy, which increases the efficacy of blood pressure correction and prophylaxis of long-term complications in patients with type 2 diabetes. In this article we want to pay attention to features of AH in patients with diabetes, to bi-directional pathogenic mechanisms, to discuss the new algorithms of the treatment and therapeutic needs of these patients. It is important to accent the understanding of the integrity and unity of pathogenic mechanisms which are needed in correction. Innovative antihyperglycemic therapy demonstrates the ability of blood pressure decrease. The synergy of effects let us successfully realize the strategy of multi-factor control and reduce a risk of micro- and macrovascular complications.

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“…When treatment with ACEI/ARB failed to reach the target of BP, ACEI/ARB in combination with CCB should be considered. This treatment has superior benefits on metabolic, renal, and cardiovascular outcomes in patients with hypertension [ 15 , 16 ]. CCB can be divided into L-type (such as amlodipine and nifedipine), L/N-type (such as cilnidipine), L/T-type (such as azelnidipine, efonidipine, mibefradil, etc.…”

Section: Introductionmentioning

confidence: 99%

N-/T-Type vs. L-Type Calcium Channel Blocker in Treating Chronic Kidney Disease: A Systematic Review and Meta-Analysis

et al. 2023

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Renin-angiotensin system (RAS) inhibitors and calcium channel blockers (CCB) are often used together in chronic kidney disease (CKD). The PubMed, EMBASE, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) in order to explore better subtypes of CCB for the treatment of CKD. This meta-analysis of 12 RCTs with 967 CKD patients who were treated with RAS inhibitors demonstrated that, when compared with L-type CCB, N-/T-type CCB was superior in reducing urine albumin/protein excretion (SMD, −0.41; 95% CI, −0.64 to −0.18; p < 0.001) and aldosterone, without influencing serum creatinine (WMD, −3.64; 95% CI, −11.63 to 4.35; p = 0.37), glomerular filtration rate (SMD, 0.06; 95% CI, −0.13 to 0.25; p = 0.53), and adverse effects (RR, 0.95; 95% CI, 0.35 to 2.58; p = 0.93). In addition, N-/T-type CCB did not decrease the systolic blood pressure (BP) (WMD, 0.17; 95% CI, −1.05 to 1.39; p = 0.79) or diastolic BP (WMD, 0.64; 95% CI, −0.55 to 1.83; p = 0.29) when compared with L-type CCB. In CKD patients treated with RAS inhibitors, N-/T-type CCB is more effective than L-type CCB in reducing urine albumin/protein excretion without increased serum creatinine, decreased glomerular filtration rate, and increased adverse effects. The additional benefit is independent of BP and may be associated with decreased aldosterone (PROSPERO, CRD42020197560).

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The benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers combined with calcium channel blockers on metabolic, renal, and cardiovascular outcomes in hypertensive patients: a meta-analysis

Cited by 17 publications

References 104 publications

An overview of the effects of combination therapy with a renin-angiotensin system blocker plus a calcium channel blocker on glucose homeostasis in non-diabetic hypertensive patients

An overview of the effects of combination therapy with a renin-angiotensin system blocker plus a calcium channel blocker on glucose homeostasis in non-diabetic hypertensive patients

The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus

N-/T-Type vs. L-Type Calcium Channel Blocker in Treating Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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