Uncontrolled hypertension can lead to kidney damage. Blood pressure targets vary depending on comorbid conditions such as diabetes and chronic kidney disease (CKD) and maintaining blood pressure below the given target is essential. Studies have shown that the majority of hypertensive patients require at least two agents to control blood pressure and urinary protein levels.

In this review, the meta-analysis technique was used to compare the renoprotective effects between calcium channel blocker (CCB) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) and ACEI/ARB plus diuretic in patients undergoing hypertension treatment.

14 randomized controlled trials (RCTs) were identified and consisted of a total of 18,125 patients with hypertension. Out of them, 8 RCTs enrolled Asian subjects only, whereas the other 6 RCTs were led in either mixed-race or not known race populations. The outcomes of the analysis such as changes in urinary protein from baseline, estimated glomerular filtration rate/creatinine clearance (eGFR/CrCl), or serum creatinine were also considered.

Based on the results of14 RCTs with 18,125 patients, significant benefits were found in CCB plus ACEI/ARB for maintaining eGFR/CrCl (standardized mean difference=0.36; P<0.001), serum creatinine reduction (mean difference (MD) = - 0.05 mg/dL; P<0.001). No significant differences were seen in terms of urinary protein (MD=7.48%; P=0.28; I²=92%). Sensitivity and subgroup analyses produced reliable results displaying a better renoprotective effect of CCB plus ACEI/ARB than ACEI/ARB plus diuretic. This meta-analysis with 14 RCTs, has shown a reliable conclusion of better efficacy of CCB plus ACEI/ARB by using two different surrogate biomarkers: eGFR/CrCl and serum creatinine.

Thus, in conclusion, this meta-analysis has shown a significantly beneficial effect of CCB plus ACEI/ARB therapy on maintaining eGFR/CrCl and reducing serum creatinine as compared to ACEI/ARB plus diuretic.

Source: Cheng Y, Huang R, Kim S, Zhao Y, Li Y, Fu P. Renoprotective effects of renin-angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2016; 95(28):e4167.