title: Renoprotective effects of renin-angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients: A PRISMA-compliant meta-analysis.
abstract: OBJECTIVE
  To conduct a meta-analysis of studies comparing the renoprotective effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) combined with either calcium channel blocker (CCB) or diuretic, but not both, in hypertensive patients.
  
  
  METHODS
  Pubmed, Embase, Medline, and Cochrane databases were searched to identify randomized controlled trials (RCTs) of blood pressure lowering treatments in patients with hypertension.
  
  
  METHODS
  RCTs comparing the renoprotective effects of ACEI/ARB plus CCB with ACEI/ARB plus diuretic in hypertensive patients, with at least one of the following reported outcomes: urinary protein, estimated glomerular filtration rate/creatinine clearance (eGFR/CrCl), or serum creatinine.
  
  
  RESULTS
  Based on 14 RCTs with 18,125 patients, statistically significant benefits were found in ACEI/ARB plus CCB for maintaining eGFR/CrCl (standardized mean difference [SMD] = 0.36; 95% confidence interval [CI]: 0.20-0.53; P < 0.001), serum creatinine reduction (mean difference [MD] = -0.05 mg/dL; 95% CI: -0.07 to -0.03; P < 0.001). However, no statistical differences were found between the 2 therapeutic strategies in terms of urinary protein (MD = 7.48%; 95% CI: -6.13% to 21.08%; P = 0.28; I = 92%).
  
  
  CONCLUSIONS
  This meta-analysis concluded that ACEI/ARB plus CCB have a stronger effect on the maintenance of renal function in patients with hypertension than ACEI/ARB plus diuretic.
authors.affiliation: Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan Department of Biostatistics, University of Michigan School of Public Health Kidney Epidemiology and Cost Center, University of Michigan, MI West China Biostatistics and Cost-Benefit Analysis Center West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Cheng
authors.forename: Rongshuang
authors.initials: R
authors.lastname: Huang
authors.forename: Sehee
authors.initials: S
authors.lastname: Kim
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Ping
authors.initials: P
authors.lastname: Fu
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D002121:Calcium Channel Blockers; D004232:Diuretics; D003404:Creatinine