KoKo Aung, MD, MPH, CPH
In patients with hypertension, does adding a renin–angiotensin system (RAS) blocker to a calcium-channel blocker (CCB) reduce CCB-associated peripheral edema?
Included studies compared a combination of a CCB with an RAS blocker (angiotensin-converting enzyme [ACE] inhibitor, angiotensin-receptor blocker [ARB], or direct renin inhibitor) with CCB monotherapy in a sample of ≥ 100 patients with hypertension and reported peripheral edema or patient withdrawal due to edema at ≥ 4 weeks. Studies that did not test equivalent doses of CCBs in both groups were excluded.
PubMed (to March 2010) and Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 2, 2009) were searched for randomized controlled trials (RCTs) that were fully published in peer-reviewed journals; reference lists of identified articles were reviewed. 25 RCTs (n = 17 206, mean age 56 y, 55% men) met the selection criteria. 8 RCTs were judged to have low risk for bias.
Overall, combination CCB–RAS blocker therapy reduced risk for edema and patient withdrawal due to edema more than CCB monotherapy (Table). Combination therapy using ACE inhibitors or ARBs reduced edema and patient withdrawal due to edema more than CCB monotherapy; combination therapy using aliskiren did not (Table).
Adding an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker to a calcium-channel blocker (CCB) reduces CCB-associated peripheral edema in patients with hypertension.
Calcium-channel blocker (CCB) plus renin–angiotensin system (RAS) blocker vs CCB monotherapy in patients with hypertension*
*ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from control event rates and risk ratios in article using a random-effects model for peripheral edema and a fixed-effect model for withdrawal due to edema.
Aung K. Review: Adding an ACE inhibitor or ARB to CCB therapy reduces CCB-associated edema in patients with hypertension. Ann Intern Med. 2011;155:JC1–11. doi: 10.7326/0003-4819-155-2-201107190-02011
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Published: Ann Intern Med. 2011;155(2):JC1-11.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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