Comparative Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers in Hypertensive Patients With Chronic Kidney Disease: A Systematic Review

This systematic review evaluates the comparative efficacy and safety of antihypertensive therapies, including angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs), in managing hypertension among chronic kidney disease (CKD) patients. A comprehensive search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted across five databases, identifying eight randomized controlled trials (RCTs) published in the last five years. The included studies examined diverse populations, ranging from pediatric to elderly CKD patients, with interventions tailored to specific subgroups, including those with proteinuria or diabetic kidney disease. Key outcomes assessed included changes in estimated glomerular filtration rate (eGFR), proteinuria reduction, cardiovascular events, and treatment-related adverse effects. Findings highlighted the superiority of ACEis and ARBs in reducing proteinuria and slowing CKD progression, particularly in proteinuric patients, while CCBs were effective in blood pressure control and improving cardiovascular parameters. However, no head-to-head trials directly comparing renin-angiotensin-aldosterone system (RAAS) inhibitors (ACEis/ARBs) and CCBs were identified, limiting definitive conclusions regarding their relative efficacy. Limitations such as small sample sizes and short follow-up durations were also noted in some studies. This review underscores the importance of individualized therapy based on patient-specific factors to optimize renal and cardiovascular outcomes. Further research is recommended to explore long-term outcomes and combination therapies in this population.