Effectiveness And Metabolic Effects Of Combination Anti-hypertension Therapy In Patient With Hypertension: A Systematic Review

Objective: Systematic review the effects of renin-angiotensin system inhibitors plus calciumchannel blockers group(RC) and renin-angiotensin system inhibitors plus thiazide diuretics group(RD) on antihypertensive efficacy, carbohydrate metabolism, lipid metabolism, electrolyte and renal function in patients with primary hypertension.Methods: Such databases as Pub Med, EMbase, Web of Science, The Cochrane Library,CBM, CNKI, VIP and Wan Fang Data were electronically searched for relevant studies from inception to January, 2016. Two reviewers independently screened literatures, extracted data, and assessed the methodological quality of the included studies according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration. The Meta-analysis was performed using Rev Man 5.3 software.Results: 23 studies consisting of 8495 patients with primary hypertension were included. The results of systematic review showed that RC group was more effective than RD group in decreasing diastolic blood pressure(DBP) in short term[MD=-1.09, 95%CI(-1.75,-0.44), P=0.001]. RC group increased serum sodium[MD=0.30, 95%CI(0.14, 0.46), P=0.0003], estimated glomerular filtration rate(e GFR)[MD=7.39, 95%CI(5.75, 9.03), P<0.00001],reduced triglyceride(TG)[MD=-0.17, 95%CI(-0.32,-0.02), P=0.02], serumuric acid[MD=-0.66,95%CI(-0.87,-0.45), P<0.00001] and serum creatinine level of diabetes mellitus or abnormal kidney function group[MD=-0.65, 95%CI(-0.88,-0.42), P<0.00001] compare with RD group. But no significant differences were found between the two groups in the rate of mark blood pressure[OR=0.99, 95%CI(0.89, 1.09), P=0.78], the change of systolic blood pressure(SBP)[MD=-0.25, 95%CI(-0.82, 0.32), P=0.39], DBP in long-term[MD=-0.50, 95%C I(-1.02, 0.02), P=0.06],total cholesterol(TC)[MD=-0.04, 95%CI(-0.20, 0.12), P=0.65], high density lipoprotein-cholesterol(HDL-C)[MD=0.24, 95%CI(-0.02, 0.50), P=0.07], low density lipoprotein-cholesterol(LDL-C)[MD=-0.14, 95%CI(-0.44, 0.15), P=0.34], haemoglobin A1c(Hb A1c)[MD=-0.09, 95%CI(-0.21, 0.04), P=0.19], fasting plasma glucose(FPG)[MD=-0.05, 95%CI(-0.18, 0.09), P=0.52], serum potassium[MD=0.02, 95%CI(-0.04, 0.08), P=0.43] and serum creatinine level of hypertension without obvious abnormal kidney function or diabetes mellitus group[MD=-0.02, 95%CI(-0.26, 0.21), P=0.85].Conclusion: RC group combination anti-hypertension was better than RD group in reducing DBP in short-term, tend to be betterthan RD group in long-term. RD group treatment easily induced high blood triglycerides, high uric acid hematic disease, hyponatremia in primary hypertension and increase the serum creatinine level of primary hypertension with obvious abnormal renal function or diabetes mellitus compared with RC group. With some limitations of the systematic review, we still need further large randomized controlled clinical study to argument.