Cheng Yiming, Huang Rongshuang, Kim Sehee, Zhao Yuliang, Li Yi, Fu Ping
Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan Department of Biostatistics, University of Michigan School of Public Health Kidney Epidemiology and Cost Center, University of Michigan, MI West China Biostatistics and Cost-Benefit Analysis Center West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2016 Jul;95(28):e4167. doi: 10.1097/MD.0000000000004167.
To conduct a meta-analysis of studies comparing the renoprotective effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) combined with either calcium channel blocker (CCB) or diuretic, but not both, in hypertensive patients.
Pubmed, Embase, Medline, and Cochrane databases were searched to identify randomized controlled trials (RCTs) of blood pressure lowering treatments in patients with hypertension.
RCTs comparing the renoprotective effects of ACEI/ARB plus CCB with ACEI/ARB plus diuretic in hypertensive patients, with at least one of the following reported outcomes: urinary protein, estimated glomerular filtration rate/creatinine clearance (eGFR/CrCl), or serum creatinine.
Based on 14 RCTs with 18,125 patients, statistically significant benefits were found in ACEI/ARB plus CCB for maintaining eGFR/CrCl (standardized mean difference [SMD] = 0.36; 95% confidence interval [CI]: 0.20-0.53; P < 0.001), serum creatinine reduction (mean difference [MD] = -0.05 mg/dL; 95% CI: -0.07 to -0.03; P < 0.001). However, no statistical differences were found between the 2 therapeutic strategies in terms of urinary protein (MD = 7.48%; 95% CI: -6.13% to 21.08%; P = 0.28; I = 92%).
This meta-analysis concluded that ACEI/ARB plus CCB have a stronger effect on the maintenance of renal function in patients with hypertension than ACEI/ARB plus diuretic.
对比较血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）联合钙通道阻滞剂（CCB）或利尿剂（但不同时联合两者）对高血压患者肾脏保护作用的研究进行荟萃分析。
检索了PubMed、Embase、Medline和Cochrane数据库，以识别高血压患者降压治疗的随机对照试验（RCT）。
比较ACEI/ARB加CCB与ACEI/ARB加利尿剂对高血压患者肾脏保护作用的RCT，报告了以下至少一项结果：尿蛋白、估计肾小球滤过率/肌酐清除率（eGFR/CrCl）或血清肌酐。
基于14项包含18125例患者的RCT，发现ACEI/ARB加CCB在维持eGFR/CrCl方面具有统计学显著益处（标准化均数差[SMD]=0.36；95%置信区间[CI]：0.20 - 0.53；P<0.001），血清肌酐降低（均数差[MD]= - 0.05mg/dL；95%CI： - 0.07至 - 0.03；P<0.001）。然而，在尿蛋白方面，两种治疗策略之间未发现统计学差异（MD = 7.48%；95%CI： - 6.13%至21.08%；P = 0.28；I² = 92%）。
该荟萃分析得出结论，ACEI/ARB加CCB对高血压患者肾功能的维持作用强于ACEI/ARB加利尿剂。
