Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Figures & data

Figure 1. Study selection process.

Table 1. Study characteristics comparing the therapeutic benefits and risks of CCBs therapy versus ACEIs or ARBs therapy.

Clinical trials	Year	Agent and daily dose (mg)	n	Age* (years)	Men (%)	Mean follow-up	SBP* (mm Hg)	DBP* (mm Hg)	Diabetes	HT	RCT	Multi-center
FACET^38	1998	amlodipine (10 mg/day)	191	63.3 (0.4)	55.5	3.5 years	171 (1)	94 (1)	Y	Y	Y	N
		fosinopril (20 mg/day)	189	62.8 (0.5)	63.5	3.5 years	170 (1)	95 (1)
		ABCD^39	1998	nisoldipine (10,20/40/60 mg/day)	235	57.2 (8.2)	68.1	5 years					155 (19)	98 (7)	Y	Y	Y	N
enalapril (5,10/20/40 mg/day)	235			57.7 (8.4)	66.8	5 years	156 (17)	98 (7)
STOP-2^40	1999			felodipine 2.5 mg or isradipine 2–5 mg daily	2196	75·9	34.0	54 months	194	98	P	Y	Y	Y
		enalapril 10 mg or lisinopril 10 mg daily	2205	76·1	33.7	54 months	194	98
		AASK^41	2001	amlodipine (5–10 mg/day)	211	54.4 (10.7)	59.9	36 months	150.0 (25.3)	95.7 (14.1)					N	Y	Y	Y
ramipril (2.5–10 mg/day)	433			54.2 (10.9)	61.2	37 months	151.0 (23.3)	96.0 (14.5)
Lewis^42	2001			amlodipine (10 mg/day)	567	59.1 (7.9)	65	30.8 months	159 (19)	87 (11)	Y	Y	Y	Y
		irbesartan (300 mg/day)	579	59.3 (7.1)	63	31.7 months	160 (20)	87 (11)
		Marin^43	2001	Nifedipine (30–60 mg/day)	112	56 (14)	57.1	>3 years	157.5(20)	96 (11)					N	Y	Y	Y
fosinopril (10–30 mg/day)	129			53 (14)	60.9	>3 years	155 (17)	96 (8)
ALLHAT1^44	2005			amlodipine (2.5, 5, and 10 mg/day)	3213	66.1 (7.9)	45.6	4.9 years	146.1 (15.9)	84.7 (10.3)	P	Y	Y	Y
		lisinopril (10, 20, and 40 mg/day)	3210	66.3 (7.8)	45.6	4.9 years	146.2 (15.8)	84.9 (10.2)
		ALLHAT2^44	2005	amlodipine (2.5, 5, and 10 mg/day)	5835	67.3 (7.6)	56.6	4.9 years	146.3 (15.6)	83.5 (10.1)					P	Y	Y	Y
lisinopril (10, 20, and 40 mg/day)	5844			67.2 (7.7)	58.2	4.9 years	146.5 (15.4)	83.7 (9.9)
Esnault^45	2008			amlodipine (5-10 mg/day)	132	58.3 (11.3)	59	2.9 years	165.1 (15.4)	102.0 (6.7)	N	Y	Y	Y
		enalapril (5-20 mg/day)	131	57.5 (12.9)	60	2.9 years	165.2 (16.6)	102.5 (7.1)

Notes: Values are mean (±SD).

SBP and DBP: systolic and diastolic blood pressure; HT: hypertension; RCT: randomized controlled trial; Y: yes; N: no; P: partial.

*Values are mean (SD).

Table 2. Study outcomes comparing the therapeutic benefits and risks of CCBs therapy versus ACEIs or ARBs therapy.

Clinical trials	SBP (mm Hg)		DBP (mm Hg)		ESRD(n/N)		All-cause Mortality(n/N)
	CCBs	ACEIs or ARBs	CCBs	ACEIs or ARBs	CCBs	ACEIs or ARBs	CCBs	ACEIs or ARBs
	FACET^38	153 (1)	157 (1)	86 (1)	88 (1)	NS	NS	5/191	4/189
ABCD^39	NS	NS	NS	NS	NS	NS	17/235	13/235
STOP-2^40	159	159	80	81	NS	NS	362/2196	380/2205
AASK^41	133 (12)	135 (14)	81 (8)	82 (9)	32/211	47/433	13/211	18/243
Lewis^42	141	144	77	77	104/567	82/579	83/567	87/579
Marin^43	143.5	135.2	81.1	83.3	40/112	27/129	6/112	4/129
ALLHAT1^44	136.8 (16.3)	138.4 (18.6)	77.8 (9.8)	78.9 (11.0)	65/3213	71/3210	481/3213	520/3210
ALLHAT2^44	133.8 (14.2)	134.1 (16.3)	74.7 (9.2)	75.5 (9.9)	64/5835	55/5844	775/5835	794/5844
Esnault^45	140.1	140.3	85.4	86.4	8/128	6/130	1/128	3/130

Notes: Values are mean (±SD).

SBP and DBP: systolic and diastolic blood pressure; CCBs: calcium-channel blockers; ACEIs: angiotensin-converting-enzyme inhibitors; ARBs: angiotensin-II receptor blockers; ESRD: end-stage renal desease; n/N: events/total patients; NS: not stated.

Figure 2. Risk of ESRD in patients receiving CCBs therapy or ACEIs/ARBs therapy. The meta-analysis of ESRD showed significantly more events with CCBs therapy compared with ACEIs or ARBs therapy (OR, 1.25; 95% CI, 1.05–1.48; P = 0.01). CI indicates confidence interval; OR: odds ratio; ESRD: end-stage renal disease; CCBs: calcium-channel blockers; ACEIs: angiotensin-converting-enzyme inhibitors; ARBs: angiotensin-II receptor blockers.

Figure 3. Risk of all-cause mortality in patients receiving CCBs therapy or ACEIs/ARBs therapy. There was no significant difference in the incidence of all-cause mortality between the two groups (OR, 0.96; 95% CI, 0.89–1.03; P = 0.24). CI: confidence interval; OR: odds ratio; CCBs, calcium-channel blockers; ACEIs: angiotensin-converting-enzyme inhibitors; ARBs: angiotensin-II receptor blockers.

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