Lu Z, Chen Y, Li L, Wang G, Xue H, Tang W
Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.
J Hum Hypertens. 2017 Jan;31(1):1-13. doi: 10.1038/jhh.2015.125. Epub 2016 Jan 7.
Many randomized clinical trials (RCTs) have investigated the efficacy and safety of renin-angiotensin system inhibitors (RASIs) plus calcium channel blockers (CCBs), compared with other two-drug combinations, but systematic assessment in this aspect is still lacking. We carried out the present meta-analysis of randomized controlled trials to evaluate the long-term effect and safety of RASIs plus CCBs. Literatures were searched in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials in September 2014. A fixed-effect model was used to estimate the pooled effect of trials identified. Thirty-four trials with 41 694 patients were included. Compared with RASIs plus diuretics, RASIs plus CCBs decreased total cardiovascular (CV) events (relative risk (RR) 0.82, 95% confidence interval (CI): 0.75, 0.91, adjusted RR (ARR) 1.7%) and withdrawals due to adverse effect (WDAE) (RR 0.87, 95% CI: 0.80, 0.94, ARR 1.3%). Compared with CCBs plus diuretics, RASIs plus CCBs decreased WDAE (RR 0.63, 95% CI: 0.45, 0.90, ARR 1.1%). Our meta-analysis indicates that RASIs plus CCBs provide a superior safety and prevention of CV events to RASIs plus diuretics, whereas this combination is also safer than CCBs plus diuretics. We also raise a new hypothesis. More high-quality RCTs focused on hard end points with CV, cerebrovascular and renal events are needed to confirm the hypothesis we have brought out.
许多随机临床试验（RCT）研究了肾素-血管紧张素系统抑制剂（RASI）加钙通道阻滞剂（CCB）与其他两种药物联合使用的疗效和安全性，但在这方面仍缺乏系统评估。我们进行了本次随机对照试验的荟萃分析，以评估RASI加CCB的长期效果和安全性。2014年9月在MEDLINE、EMBASE和Cochrane对照试验中央登记册中检索文献。采用固定效应模型估计所纳入试验的合并效应。纳入了34项试验，共41694例患者。与RASI加利尿剂相比，RASI加CCB降低了总心血管（CV）事件（相对风险（RR）0.82，95%置信区间（CI）：0.75，0.91，调整后RR（ARR）1.7%）以及因不良反应导致的停药率（WDAE）（RR 0.87，95%CI：0.80，0.94，ARR 1.3%）。与CCB加利尿剂相比，RASI加CCB降低了WDAE（RR 0.63，95%CI：0.45，0.90，ARR 1.1%）。我们的数据荟萃分析表明，与RASI加利尿剂相比，RASI加CCB在安全性和预防CV事件方面更具优势，而这种联合用药也比CCB加利尿剂更安全。我们还提出了一个新的假设。需要更多关注心血管、脑血管和肾脏事件等硬终点的高质量随机对照试验来证实我们提出的假设。
