Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY.
Health + Hospitals/Metropolitan Hospital, Department of Medicine, New York Medical College, New York, NY.
Am J Med. 2021 Jan;134(1):104-113.e3. doi: 10.1016/j.amjmed.2020.05.039. Epub 2020 Jul 6.
Inhibitors of the renin-angiotensin system are recommended for the management of albuminuria in patients with hypertension and diabetes mellitus, but there is little consensus about alternative therapies. Calcium channel blockers are recommended for the management of hypertension, but the data are controversial regarding their role in patients with albuminuria. This review was designed to assess the efficacy of calcium channel blockers compared with inhibitors of the renin-angiotensin system in decreasing albuminuria in diabetic, hypertensive patients with nephropathy.
We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for records that compared calcium channel blockers to inhibitors of the renin-angiotensin system and reported pre- and postintervention albuminuria measurements. Two reviewers independently screened abstracts for randomized, controlled trials in adults. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select 29 trials from 855 records. We synthesized the data through a random-effects model.
We analyzed data from 2113 trial participants with hypertension and diabetes mellitus who had the equivalent of ≥30 mg/day of urinary albumin excretion. Inhibitors of the renin-angiotensin system were more effective than calcium channel blockers in decreasing albuminuria (standardized difference in means -0.442; confidence interval, -0.660 to -0.225; P < .001). This finding was independent of the blood pressure response to treatment. There was no difference between the 2 drug classes regarding markers of renal function.
Inhibitors of the renin-angiotensin system are superior to calcium channel blockers for the reduction of albuminuria in nephropathy due to hypertension and diabetes mellitus. The net clinical benefit, however, is small.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体拮抗剂（ARB）被推荐用于治疗高血压合并糖尿病患者的蛋白尿，但对于替代治疗方案，目前仍存在较大争议。钙通道阻滞剂（CCB）被推荐用于治疗高血压，但有关其在蛋白尿患者中的作用的数据存在争议。本综述旨在评估 CCB 与 ACEI/ARB 相比，在降低合并肾病的高血压、糖尿病患者蛋白尿方面的疗效。
我们检索了 MEDLINE、Embase、CENTRAL 和 ClinicalTrials.gov，以查找将 CCB 与 ACEI/ARB 进行比较，并报告干预前后蛋白尿测量值的研究记录。两位评审员独立筛选了成人随机对照试验的摘要。我们使用系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南，从 855 条记录中选择了 29 项试验。我们通过随机效应模型对数据进行综合分析。
我们分析了 2113 名患有高血压和糖尿病且尿白蛋白排泄量≥30mg/天的试验参与者的数据。ACEI/ARB 比 CCB 更能有效降低蛋白尿（标准化均数差值-0.442；置信区间，-0.660 至-0.225；P<0.001）。这一发现与治疗后的血压反应无关。两种药物类别在肾功能标志物方面没有差异。
ACEI/ARB 比 CCB 更能有效降低高血压合并糖尿病引起的肾病患者的蛋白尿。然而，净临床获益较小。
