Chronic kidney disease (CKD) is displayed by decreased glomerular filtration rate (GFR). Globally, CKD is a public health disorder and a higher incidence can be seen in the older population. Evidence shows that decreased GFR is an independent risk factor for cardiovascular (CV) events. The National Kidney Foundation Task Force and a statement from the American Heart Association Councils have recommended that CKD patients should be considered as a high-risk group for consequent CV events and the treatment recommendation should be based on CV risk stratification. The calcium channel blocker (CCB) and angiotensin II receptor blocker (ARB) combination is recommended as one of the most preferred combination therapies for the general hypertensive people.

A multicenter, prospective randomized open-label blinded end-point study was conducted to compare the preventive effect of CCB plus ARB combination therapy versus high-dose ARB therapy in the prevention of CV morbidity and mortality. The study included 1164 elderly hypertensive patients with baseline cardiovascular disease and/or type 2 diabetes. A subgroup analysis of the study according to baseline estimated GFR (eGFR) with CKD defined as an eGFR < 60 ml/min per 1.73m² was performed.

Blood pressure was lower with the combination therapy than the high-dose ARB therapy in both with and without CKD groups. In patients with CKD, more primary events (a composite of CV events and non-cardiovascular death) occurred in the high-dose ARB treatment group compared to the combination group (30 patients vs. 16 patients, respectively, hazard ratio 2.25). Also, more cerebrovascular and heart failure events occurred in the high-dose ARB treatment group versus the combination group. In patients without CKD, the occurrence of primary events appeared to be similar between the 2 treatment groups. Assignment to high-dose ARB treatment was an important independent prognostic factor for primary events in patients with CKD.

Thus, the study concluded that the CCB plus ARB combination therapy was more effective in the prevention of cardiovascular morbidity and mortality among elderly high-risk hypertensive patients with baseline CKD as compared to high-dose ARB therapy alone.

Source: Kim-Mitsuyama S, Ogawa H, Matsui K, Jinnouchi T, Jinnouchi H, Arakawa K. An angiotensin II receptor blocker-calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blockade alone. Kidney Int. 2012; 83(1):167-176. doi:10.1038/ki.2012.326