Key result
Combination treatment with amlodipine and ACE inhibitors resulted in a greater reduction of systolic blood pressure than amlodipine monotherapy (WMD 5.72; 95% CI 4.10-7.33).
Why the study?
Does the combination of amlodipine and ACE inhibitors improve blood pressure control and tolerability in patients with hypertension compared to amlodipine monotherapy?
Meta-Analysis (n=3,291)
Does the combination of amlodipine and ACE inhibitors improve blood pressure control and tolerability in patients with hypertension compared to amlodipine monotherapy?
Mean Difference: 5.72 (95% CI 4.1–7.33)
The combination of amlodipine and an ACE inhibitor provides superior blood pressure control and fewer overall adverse events, including less edema, compared to amlodipine monotherapy in hypertensive patients.
Supports amlodipine-ACE inhibitor combination for greater systolic BP reduction in hypertension; confirms meta-analytic benefit over monotherapy.
OBJECTIVE: This study aimed to estimate the efficacy and tolerability of the combination of amlodipine and angiotensin-converting enzyme inhibitors as compared with amlodipine monotherapy in the treatment of hypertension. METHODS: The Cochrane Central Register of Controlled Trials, PubMed, and Embase were searched for relevant articles. A random effect model of meta-analysis was used for the selected randomized controlled trials (RCTs). RESULTS: A total of 17 randomized controlled trials involving 3291 patients were identified using predefined criteria. The combination treatment of amlodipine and angiotensin-converting enzyme inhibitors resulted in a greater reduction of both systolic blood pressure (SBP) [weighted mean difference (WMD) 5.72, 95% CI: (confidence interval) 4.10-7.33] and diastolic blood pressure (DBP) (WMD 3.62, 95% CI: 4.85-2.39) than monotherapy. The combination treatment also generated significantly greater reductions for the mean ambulatory SBP and DBP during the full 24 hours (WMD: SBP 4.24, 95% CI: 6.82-1.67; DBP 2.23, 95% CI: 3.73-0.69), but not for the trough (WMD: SBP 4.52, 9.56 to -0.51; DBP 3.7, 7.65 to -0.25). The hypertension therapeutic control (SPB <140, DBP <90 mmHg) rate for the combination treatment is higher than that for monotherapy [relative risk (RR): 1.36, 95% CI: 1.07-1.73]. The combination treatment also resulted in a lower overall rate of adverse events (RR: 0.86, 95% CI: 0.75-0.99) and edema (RR: 0.40, 95% CI: 0.29-0.56), but a higher rate of cough (RR: 3.28, 95% CI: 2.03-5.29) as compared with monotherapy. CONCLUSION: This meta-analysis suggests that the combination treatment provides superior BP control, fewer adverse events, and better tolerability in hypertensive patients than monotherapy. Further research should explore the mechanism of the combination therapy and whether it is associated with the reduction of cardiovascular disease morbidity and mortality.
No takes yet. Share an insight, caveat, or question.
Lv et al. (2010) conducted a meta-analysis in hypertension (n=3,291). amlodipine and angiotensin-converting enzyme inhibitor combination vs. amlodipine monotherapy was evaluated on reduction of systolic blood pressure (SBP) (WMD 5.72, 95% CI 4.10-7.33). Combination treatment with amlodipine and ACE inhibitors resulted in a greater reduction of systolic blood pressure than amlodipine monotherapy (WMD 5.72; 95% CI 4.10-7.33).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: