Key result
An ARB-based CCB combination regimen substantially reduced the odds of major cardiovascular disease events compared to ACEI monotherapy (OR 3.19) and ARB monotherapy (OR 2.64) in non-dialysis CKD patients.
Why the study?
The clinical outcomes associated with renin angiotensin system inhibitor-based dual antihypertensive regimens in non-dialysis chronic kidney disease patients needed comprehensive investigation.
Does an ARB-based CCB combination therapy reduce major CVD events and blood pressure in non-dialysis CKD patients compared to other antihypertensive regimens?
Meta-Analysis (n=4,677)
Does an ARB-based CCB combination therapy reduce major CVD events and blood pressure in non-dialysis CKD patients compared to other antihypertensive regimens?
Effect estimate: OR 3.19 (95% CI 1.25-8.17)
p-value: p=0.0156
In non-dialysis CKD patients, an ARB-based CCB combination regimen provides the greatest benefits in blood pressure reduction and lowering major CVD risks compared to RASi monotherapy and other combinations.
Supports ARB+CCB dual therapy over RASi monotherapy for CVD prevention in non-dialysis CKD; extends network evidence from 16 RCTs.
This study comprehensively investigated clinical outcomes associated with renin angiotensin system inhibitor-based dual antihypertensive regimens in non-dialysis chronic kidney disease (CKD) patients. Keyword searches of databases were performed per PRISMA-NMA guidelines. Frequentist network meta-analysis were conducted with 16 head-to-head randomized controlled trials. The effect sizes of dichotomous and continuous variables were estimated with odds ratio (OR) and standard mean differences (SMD), respectively. The protocol is registered in PROSPERO (CRD42022365927). Dual antihypertensive regimens with combination of angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) demonstrated substantially reduced odd of major cardiovascular disease (CVD) events over other regimens including angiotensin converting enzyme inhibitor (ACEI) monotherapy (OR 3.19) and ARB monotherapy (OR 2.64). Most significant reductions in systolic (SBP) and diastolic blood pressure (DBP) were observed with ARB-based CCB dual regimen over ACEI monotherapy (SMD 17.60 SBP and 9.40 for DBP), ACEI-based CCB regimen (SMD 12.90 for SBP and 9.90 for DBP), and ARB monotherapy (SMD 13.20 for SBP and 5.00 for DBP). However, insignificant differences were noticed for the odds of hyperkalemia, end stage renal disease progression, and all-cause mortality. ARB-based CCB regimen has the greatest benefits on BP reduction as well as major CVD risks in non-dialysis CKD patients.
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Cho et al. (2023) conducted a meta-analysis in Non-dialysis chronic kidney disease (CKD) with hypertension (n=4,677). Angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) combination vs. ACEI monotherapy was evaluated on Major cardiovascular disease (CVD) events (OR 3.19, 95% CI 1.25-8.17, p=0.0156). An ARB-based CCB combination regimen substantially reduced the odds of major cardiovascular disease events compared to ACEI monotherapy (OR 3.19) and ARB monotherapy (OR 2.64) in non-dialysis CKD patients.
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