Combination therapy of renin–angiotensin system inhibitors plus calcium channel blockers versus other two-drug combinations for hypertension: a systematic review and meta-analysis

2016 ◽  
Vol 31 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Z Lu ◽  
Y Chen ◽  
L Li ◽  
G Wang ◽  
H Xue ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Drug Combinations ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin

scholarly journals Risk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive Therapy

Hypertension ◽  
2020 ◽  
Vol 75 (4) ◽  
pp. 966-972 ◽  
Author(s):  
Maria Lukács Krogager ◽  
Rikke Nørmark Mortensen ◽  
Peter Enemark Lund ◽  
Henrik Bøggild ◽  
Steen Møller Hansen ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Calcium Channel ◽  
Antihypertensive Therapy ◽  
Calcium Channel Blockers ◽  
Odds Ratio ◽  
Renin Angiotensin System ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Β Blockers

Little is known about the occurrence of hypokalemia due to combination therapy for hypertension. Using data from Danish administrative registries, we investigated the association between different combinations of antihypertensive therapy and risk of developing hypokalemia. Using incidence density matching, 2 patients without hypokalemia were matched to a patient with hypokalemia (K, <3.5 mmol/L) on age, sex, renal function, and time between index date and date of potassium measurement. Combination therapies were subdivided into 10 groups including β-blockers (BB)+thiazides (BB+thiazides), calcium channel blockers (CCB)+renin angiotensin system inhibitors (RASi)+thiazides (CCB+RASi+Thiazides), calcium channel blockers+thiazides (CCB+thiazides), and β-blockers+renin angiotensin system inhibitors+thiazides (BB+RASi+thiazides). We used conditional logistic regression to estimate the odds of developing hypokalemia for different combinations of antihypertensive drugs within 90 days of combination therapy initiation. We matched 463 patients with hypokalemia to 926 patients with normal potassium concentrations. The multivariable analysis showed 5.82× increased odds of developing hypokalemia if administered CCB+thiazides (95% CI, 3.06–11.08) compared with CCB+RASi. Other combinations significantly associated with increased hypokalemia odds were BB+thiazides (odds ratio, 3.34 [95% CI, 1.67–6.66]), CCB+RASi+thiazides (odds ratio, 3.07 [95% CI, 1.72–5.46]), and BB+RASi+thiazides (odds ratio, 2.78 [95% CI, 1.41–5.47]). Combinations of thiazides with CCB, RASi, or BB were strongly associated with increased hypokalemia risk within 90 days of treatment initiation.

scholarly journals Rates of delirium associated with calcium channel blockers compared to diuretics, renin-angiotensin system agents and beta-blockers: An electronic health records network study

2020 ◽  
Vol 34 (8) ◽  
pp. 848-855 ◽  
Author(s):  
Paul J Harrison ◽  
Sierra Luciano ◽  
Lucy Colbourne
Keyword(s):  
Calcium Channel ◽  
Antihypertensive Drug ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Renin Angiotensin System ◽  
Negative Control ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin

Background: Antihypertensive drugs, especially calcium channel blockers, have been associated with differential rates of a number of neuropsychiatric outcomes. Delirium is commonly attributed to medication, including antihypertensive drugs, but delirium incidence has not been compared directly between antihypertensive drug classes. Methods: Using a federated electronic health records network of 25.5 million people aged 50 years or older, we measured rates of delirium over a two-year period in patients prescribed calcium channel blockers compared to the other main antihypertensive drug classes. Extensive propensity score matching was used to create cohorts matched for a range of demographic factors and delirium risk factors. Negative control outcomes were also measured. Results: Cohort sizes ranged from 54,000–577,000. Delirium was more common with calcium channel blockers than with renin-angiotensin system agents (~40% higher) but less common than with beta-blockers (~20% lower). These differences remained when patients with a range of other delirium risk factors were excluded, and they were not paralleled by the negative control outcomes. Comparisons between calcium channel blockers and diuretics produced inconclusive results. Conclusions: Calcium channel blockers are associated with higher rates of delirium than renin-angiotensin system agents, but lower rates compared to beta-blockers. The findings add to the list of factors which may be considered when choosing antihypertensive drug class.

scholarly journals The effect of Renin Angiotensin System Blockers versus Calcium Channel Blockers on Progression towards Hypertensive Chronic Kidney Disease: A comprehensive systematic review based on Randomized Controlled Trials

2020 ◽  
Author(s):  
Ameena Rafeeque ◽  
Mohammed Fasihul Alam
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Renin Angiotensin System ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin System Blockers

Background: Decline in estimated Glomerular filtration rate (eGFR) is associated with further progression of chronic kidney disease. Evidence suggests that Renin Angiotensin System blockers (RAS), which can be angiotensin-receptor blockers (ARBs) or Angiotensin converting enzymes Inhibitors (ACEIs), have reno- protective effect, but results are variable. Similarly, effects of Calcium channel blockers (CCBs) are shown to have a role in protecting renal function but differ across studies. Hence, the relative effect of ARBs or ACEIs as well as CCBs, and their administration as monotherapy, remain uncertain. Purpose: To summarize and determine the pooled effect of RAS versus CCBs on progression towards hypertensive CKD amongst diabetic as well as non-diabetic patients with CKD of any stage from I-IV. Data sources: All language studies in PubMed, the Cochrane Library Central, Clinical Registry of unpublishedTrials, WHO, Embase, Scopus, ProQuest, reference lists, and expert contacts up to September 2019. Study selection: This study included all the full text articles that studied diabetic and non-diabetic patients with eGFR ≥ 15 ml/min per 1.73m3 or Urinary albumin excretion levels (UAE) ≤ 300mg/d during RAS based treatment an intervention in direct comparison with CCBs treatment based approach as comparator at baseline and at the end of follow-up. However, pooling of all the included studies using meta-analysis was not feasible due to substantial study heterogeneity and the small number of included studies that are meta-analyzable. So, studies were selected for systematic review, and out of which, all the meta-analyzable studies were quantitatively analyzed on the basis of main outcomes such as (i) Relative risk for CKD progression and (ii) Mean differences in SBP and DBP for both the arms. Doi plot and funnel plot were used for detection of publication bias. Results: Review with seven included trials, and metaanalysis using IVhet model was done on three studies for primary CKD outcome and four studies for secondary BP outcomes. RAS blockers and CCBs did not show any statistically significant differences in terms of its effects on further progression CKD with RR of 0.90 [95% CI 0.69, 1.16]. Moreover, there was no statistically significant difference in BP from baseline to final end points between CCBs and RAS inhibitors with WMD of -2.09 mmHg [95% CI -5.96, 1.79] for mean SBP change and -0.71 mmHg [95% CI -2.16, 0.73] for mean DBP change. Conclusion: Evidence asserts no difference between RAS and CCB concerning the risk of progression for CKD and in terms of mean BP differences. However, the study have its own set of limitations due to which more well designed and well conducted RCTs with robust findings are required to confirm the inferences based on this review.

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