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The Effect of Calcium Channel Blockers on Moderate or Severe Albuminuria in Diabetic, Hypertensive Patients

Eder H Cativo1, Persio D Lopez1, Diana P Cativo2

  • 1Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY.

The American Journal of Medicine
|July 10, 2020
PubMed

Insights

Inhibitors of the renin-angiotensin system are more effective than calcium channel blockers at reducing albuminuria in diabetic patients with hypertension and kidney disease. However, the overall clinical benefit is modest.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Inhibitors of the renin-angiotensin system (RAS) are recommended for managing albuminuria in hypertensive, diabetic patients.
  • The role of calcium channel blockers (CCBs) in managing albuminuria is controversial.
  • Alternative therapies for albuminuria require further investigation.

Purpose of the Study:

  • To compare the efficacy of CCBs versus RAS inhibitors in reducing albuminuria.
  • To assess treatment effects in diabetic, hypertensive patients with nephropathy.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov.
  • Included 29 trials with 2113 participants using PRISMA guidelines.

Main Results:

  • RAS inhibitors significantly reduced albuminuria compared to CCBs (SD -0.442, P < .001).
  • Efficacy was independent of blood pressure response.
  • No significant difference in renal function markers between the two drug classes.

Conclusions:

  • RAS inhibitors are superior to CCBs for reducing albuminuria in diabetic nephropathy.
  • The net clinical benefit of RAS inhibitors over CCBs for albuminuria reduction is small.
  • Further research may be needed to optimize treatment strategies.
Abstract

Keywords:
AlbuminuriaCalcium channel blockersDiabetic nephropathyHypertensionRenin-angiotensin system blockers

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