International Urology and Nephrology

, Volume 50, Issue 12, pp 2261–2278 | Cite as

The benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers combined with calcium channel blockers on metabolic, renal, and cardiovascular outcomes in hypertensive patients: a meta-analysis

  • Punnaka Pongpanich
  • Pasvich Pitakpaiboonkul
  • Kullaya Takkavatakarn
  • Kearkiat Praditpornsilpa
  • Somchai Eiam-Ong
  • Paweena SusantitaphongEmail author
Nephrology - Original Paper



The prevalence of hypertension and its associated complications are markedly growing. Most patients need more than one drug to achieve blood pressure (BP) target. However, most guidelines only focus on the first-line treatment. We conducted a meta-analysis to explore the benefits of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) combined with calcium channel blockers (CCBs) on metabolic, renal, and cardiovascular outcomes in hypertensive patients.


A systematic literature search was conducted in MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and Clinical (until April 7, 2016) to identify randomized controlled trials (RCTs) comparing the benefits of ACEIs/ARBs combined with CCBs versus other dual or triple combinations on clinical outcomes in hypertensive patients. Random effects models were used to compute the weighted mean difference (WMD) for continuous variables.


Sixty RCTs (48,913 patients) were identified. When compared with other combinations, the combination of ACEIs/ARBs and CCBs had comparable WMD of systolic as well as diastolic BP (73 study arms) but provided better benefits on metabolic parameters, such as HDL, FBS, HbA1C, and serum uric acid; renal functions, including serum creatinine and estimated glomerular filtration rate; and cardiovascular diseases, including reduction of all cardiovascular events, myocardial infarction, and syncope/hypotension. A significant increase of serum potassium was observed.


The combination of ACEIs/ARBs with CCBs has superior benefits on metabolic, renal, and cardiovascular outcomes in hypertensive patients. Therefore, this combination should be considered whenever monotherapy does not achieve the guideline target.


ACEIs ARBs CCBs Hypertension Clinical outcomes Meta-analysis 



This work was funded by Thailand research fund Career Development Grant #RSA5880067. Thailand.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest relevant to the work.

Ethical approval

No approval of an ethics committee was required as this was a meta-analysis.

Informed consent

This article does not contain any studies with human participants performed by any of the authors and use the data from previous reports. Therefore, informed consent was not required.

Research involving human and animal participants

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

11255_2018_1991_MOESM1_ESM.tif (100 kb)
Supplementary Figure 1a Forest plot displaying the effect of the combination of ACEIs/ARBs and CCBs on change in serum creatinine (A), serum potassium (B), serum HDL (C), and HBA1C (D). (TIF 100 KB)
11255_2018_1991_MOESM2_ESM.tif (95 kb)
Supplementary Figure 1b (TIF 95 KB)
11255_2018_1991_MOESM3_ESM.tif (101 kb)
Supplementary Figure 1c (TIF 100 KB)
11255_2018_1991_MOESM4_ESM.tif (104 kb)
Supplementary Figure 1d (TIF 104 KB)
11255_2018_1991_MOESM5_ESM.pdf (632 kb)
Supplementary Table 1 (PDF 633 KB)


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Punnaka Pongpanich
    • 1
  • Pasvich Pitakpaiboonkul
    • 1
  • Kullaya Takkavatakarn
    • 1
  • Kearkiat Praditpornsilpa
    • 1
  • Somchai Eiam-Ong
    • 1
  • Paweena Susantitaphong
    • 1
    Email author
  1. 1.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand

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