A meta-analysis of the effect of angiotensin receptor blockers and calcium channel blockers on blood pressure, glycemia and the HOMA-IR index in non-diabetic patients.
OBJECTIVE
This study compared the efficacy of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in the effect of insulin resistance (IR) as assessed using the homeostasis model assessment of insulin resistance (HOMA-IR) in non-diabetic patients.


METHODS
The MEDLINE, EMBASE, and Cochrane Library databases were searched to identify studies published before December 2012 that investigated the use of ARBs and CCBs to determine the effect on the HOMA-IR index in non-diabetics. Parameters on IR and blood pressure were collected. Review Manager 5.2 and Stata 12.0 were used to perform the meta-analysis. Fixed and random effects models were applied to various aspects of the meta-analysis, which assessed the therapeutic effects of the two types of drug using the HOMA-IR index in non-diabetic patients.


RESULTS
The meta-analysis included five clinical trials. Patient comparisons before and after treatment with ARBs and CCBs revealed that ARBs reduced the HOMA-IR index (weighted mean difference (WMD) -0.65, 95% confidence interval (CI) -0.93 to -0.38) and fasting plasma insulin (FPI) (WMD -2.01, 95% CI -3.27 to -0.74) significantly more than CCBs. No significant differences in the therapeutic effects of these two types of drug on blood pressure were observed.


CONCLUSIONS
Given that there are no significant differences in the therapeutic effects of ARBs and CCBs on blood pressure, as ARBs are superior to CCBs in their effect on the HOMA-IR index in non-diabetics, they might be a better choice in hypertension patients without diabetes.
State Discipline and State Key Laboratory of Kidney Disease (Chinese PLA General Hospital, 2011DAV00088), Beijing 100853, PR China; Medical school of Nankai University, Tianjin 300071, PR China.
Yue
Y
Yang
Ri-bao
RB
Wei
Yue
Y
Xing
Lu
L
Tang
Xiao-yong
XY
Zheng
Zi-cheng
ZC
Wang
Yu-wei
YW
Gao
Min-xia
MX
Li
Xiang-mei
XM
Chen
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001786:Blood Glucose; D002121:Calcium Channel Blockers; D007328:Insulin
ACEI; ADA; ARB; AT1; American Diabetes Association; Ang II inhibits the angiotensin II receptor 1; Angiotensin receptor blockers; CCB; Calcium channel blockers; DBP; FPG; FPI; HOMA-IR; IFG; IGT; IR; Insulin resistance; Meta-analysis; PPAR-γ; RAS; RCTs; SBP; SD; SEM; WMD; angiotensin converting enzyme inhibitors; angiotensin receptor blocker; calcium channel blocker; diastolic blood pressure; fasting plasma glucose; fasting plasma insulin; homeostasis model assessment of insulin resistance; impaired fasting glucose; impaired glucose tolerance; insulin resistance; peroxisome proliferator activated receptors-gamma; randomized controlled trials; renin–angiotensin system; standard deviation; standard error of the mean; systolic blood pressure; weighted mean difference