Effects of Calcium Channel Blockers and Angiotensin Converting Enzyme Inhibitors on the Left Ventricular Hypertrophy in Chinese Hypertensive Patients: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

DING Qi ¹ ,  YU Jing ² , LI Ningyin ¹ , CHANG Peng ² , LIN Xing ² , WANG Qiongying ² , ZHANG Xueming ³

1. The Second Clinical Medical College of Lanzhou University, Lanzhou 730000, China;2. The Second Hospital of Lanzhou University, Lanzhou 730030, China;3. People’s Hospital of DingXi, Dingxi,Gansu Province,China;

Corresponding author：

YU Jing, Email: yujing2304@126.com

Keywords：

Chinese population; Hypertension; Left ventricular hypertrophy; Calcium channel blocker; Angiotensin-converting enzyme inhibitor; Meta-analysis

DOI：

10.7507/1672-2531.20120070

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Objective 　To systematically evaluate the effectiveness and safety of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) used alone v.s. used in combination on the reversion of left ventricular hypertrophy (LVH) in Chinese essential hypertension (EH) patients.
Methods 　The following databases were searched, including, Cochrane Library (Issue 7, 2011), PubMed (1980 to 2011), EMbase (1990 to 2011), CBM (1978 to 2011), CNKI (1994 to 2011), VIP (1989 to 2011), and WanFang Data (1998 to 2011). The studies were screened, and the quality was evaluated according to predefined inclusion and exclusion criteria, and then Meta-analysis was conducted by using RevMan 5.1 software.
Results 　A total of 10 studies involving 859 patients were included. The results of Meta-analysis showed that the CCBs plus ACEIs group (the combination group) was superior to the CCBs group in improving EH patients’ systolic pressure (SBP) (MD= –6.49, 95%CI –10.55 to –2.43), diastolic pressure (DBP) (MD= –4.48, 95%CI –6.76 to –2.21), left ventricular mass index (LVMI) (MD= –5.31, 95%CI –8.43 to –2.19), interventricular septal thickness (IVST) (MD= –1.33, 95%CI –2.00 to –0.66) and left ventricular posterior wall thickness (LVPWT) (MD= –0.87, 95%CI –1.41 to –0.33). In addition, compared with the ACEIs group, the combination group was greatly superior in decreasing LVMI (MD= –11.54, 95%CI –15.06 to –8.01), IVST (MD= –0.76, 95%CI –1.25 to –0.27) and LVPWT (MD= –0.80, 95%CI –1.01 to –0.59). But clinical effectiveness was similar between the combination group and the CCBs group or the ACEIs group in aspects of the left ventricular end diastolic diameter (LVEDD), fraction shortening (FS) and ejection fractions (EF) (P gt;0.05).
Conclusion　 The combination therapy of CCBs with ACEIs is superior to either the CCBs or the ACEIsmonothrepy in regression of left ventricular hypertrophy. Because of the low methodological quality and small sample, this conclusion needs to be proved by more high-quality, large-scale and multicenter randomized controlled trials in the future.

Citation： DING Qi,YU Jing,LI Ningyin,CHANG Peng,LIN Xing,WANG Qiongying,ZHANG Xueming. Effects of Calcium Channel Blockers and Angiotensin Converting Enzyme Inhibitors on the Left Ventricular Hypertrophy in Chinese Hypertensive Patients: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(4): 436-444. doi: 10.7507/1672-2531.20120070 Copy

1.	郭艺芳, 张倩辉. 2009版欧洲高血压指南解读. 中华高血压杂志, 2009, 17(12): 1057-1058.
2.	中国高血压防治指南修订委员会. 中国高血压防治指南2010. 中华心血管病杂志, 2011, 39(7): 579-616.
3.	Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens, 2011, 187(6): 1-10.
4.	Schmieder RE, Schlaich MP, Klingbeil AU, et al. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996). Nephrol Dial Transplant, 1998, 13(3): 564-569.
5.	Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens, 2009, 27(11): 2121-2158.
6.	Weder AB. The Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial: a comparison of first-line combination therapies. Expert Opin Pharmacother, 2005, 6(2): 275-281.
7.	Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet, 2005, 366(9489): 895-906.
8.	蔡建华. 赖诺普利与非洛地平缓释片联用对高血压伴左室肥厚的逆转作用. 临床心血管病杂志, 2002, 18(8): 373-374.
9.	何劲贤, 张伟宁, 吴少波. 非洛地平与贝那普利联用对高血压左室肥厚及左室舒张功能的影响. 海南医学, 2004, 15(3): 5-6.
10.	李燕. 依那普利和硝苯地平联用逆转原发性高血压左心室肥厚的临床观察. 中国误诊学杂志, 2007, 7(16): 3724.
11.	刘铁有, 王文斌, 迟永前, 等. 硝苯吡啶与卡托普利联用逆转左心室肥厚的临床观察. 齐齐哈尔医学院学报, 1996, 17(3): 178-179.
12.	刘振华, 王树德. 依那普利与硝苯地平控释片联用对高血压伴左室肥厚的疗效观察. 滨州医学院学报, 2003, 26(6): 404-405.
13.	马娜. 左旋氨氯地平联合贝那普利治疗原发性高血压并左室肥厚的疗效观察. 天津药学, 2010, 22(4): 43-44.
14.	王守风, 胡兆霆. 苯那普利和氨氯地平联合治疗对高血压患者左室肥厚和心功能的影响. 临床医学, 2000, 20(6): 11-12.
15.	张慧玲, 魏广和, 李清贤, 等. 氨氯地平与培哚普利联用对原发性高血压伴左心室肥厚的逆转作用. 济宁医学院学报, 2009, 32(1): 43-44.
16.	张建萍, 付军. 左旋氨氯地平联合培哚普利治疗老年高血压合并左室肥厚的疗效. 中国老年学杂志, 2011, 31(3): 421-422.
17.	张志强, 李福祥, 张增堂, 等. 依那普利、硝苯地平联用逆转高血压左室肥厚的效果观察. 山东医药, 1998, 38(4): 10-11.
18.	Cuspidi C, Sala C, Zanchetti A. Management of hypertension in patients with left ventricular hypertrophy. Curr Hypertens Rep, 2007, 9(6): 498-505.
19.	陈丽华. 苯磺酸左旋氨氯地平联合贝那普利治疗原发性高血压对左室肥厚的影响. 中国医学创新, 2010, 7(23): 63-64.
20.	Kannel WB. Left ventricular hypertrophy as a risk factor: the Framingham experience. J Hypertens Suppl, 1991, 9(2): S3-8.
21.	Devereux RB, Wachtell K, Gerdts E, et al. Prognostic Significance of Left Ventricular Mass Change During Treatment of Hypertension. JAMA, 2004, 292(19): 2350-2356.
22.	景晓娟, 艾永飞, 侯晓玲, 等. 优化联合降压治疗对高血压左室肥厚患者左室重量指数及血清瘦素水平的影响. 现代生物医学进展, 2009, 9(8): 1478-1480.
23.	Neutel JM, Smith HG, Weber MA. Effects of Antihypertensive Monotherapy and Combination Therapy on Arterial Distensibility and Left Ventricular Mass. AJH, 2004, 17(1): 37-42.
24.	De Rosa ML, Maddaluno G, Lionetti F, et al. Effects of enalapril and isradipine alone and in combination on blood pressure, renal function and echocardiographic parameters in mild hypertension. Int J Cardiol, 2000, 74(1): 77-84.

1. 郭艺芳, 张倩辉. 2009版欧洲高血压指南解读. 中华高血压杂志, 2009, 17(12): 1057-1058.
2. 中国高血压防治指南修订委员会. 中国高血压防治指南2010. 中华心血管病杂志, 2011, 39(7): 579-616.
3. Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens, 2011, 187(6): 1-10.
4. Schmieder RE, Schlaich MP, Klingbeil AU, et al. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996). Nephrol Dial Transplant, 1998, 13(3): 564-569.
5. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens, 2009, 27(11): 2121-2158.
6. Weder AB. The Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial: a comparison of first-line combination therapies. Expert Opin Pharmacother, 2005, 6(2): 275-281.
7. Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet, 2005, 366(9489): 895-906.
8. 蔡建华. 赖诺普利与非洛地平缓释片联用对高血压伴左室肥厚的逆转作用. 临床心血管病杂志, 2002, 18(8): 373-374.
9. 何劲贤, 张伟宁, 吴少波. 非洛地平与贝那普利联用对高血压左室肥厚及左室舒张功能的影响. 海南医学, 2004, 15(3): 5-6.
10. 李燕. 依那普利和硝苯地平联用逆转原发性高血压左心室肥厚的临床观察. 中国误诊学杂志, 2007, 7(16): 3724.
11. 刘铁有, 王文斌, 迟永前, 等. 硝苯吡啶与卡托普利联用逆转左心室肥厚的临床观察. 齐齐哈尔医学院学报, 1996, 17(3): 178-179.
12. 刘振华, 王树德. 依那普利与硝苯地平控释片联用对高血压伴左室肥厚的疗效观察. 滨州医学院学报, 2003, 26(6): 404-405.
13. 马娜. 左旋氨氯地平联合贝那普利治疗原发性高血压并左室肥厚的疗效观察. 天津药学, 2010, 22(4): 43-44.
14. 王守风, 胡兆霆. 苯那普利和氨氯地平联合治疗对高血压患者左室肥厚和心功能的影响. 临床医学, 2000, 20(6): 11-12.
15. 张慧玲, 魏广和, 李清贤, 等. 氨氯地平与培哚普利联用对原发性高血压伴左心室肥厚的逆转作用. 济宁医学院学报, 2009, 32(1): 43-44.
16. 张建萍, 付军. 左旋氨氯地平联合培哚普利治疗老年高血压合并左室肥厚的疗效. 中国老年学杂志, 2011, 31(3): 421-422.
17. 张志强, 李福祥, 张增堂, 等. 依那普利、硝苯地平联用逆转高血压左室肥厚的效果观察. 山东医药, 1998, 38(4): 10-11.
18. Cuspidi C, Sala C, Zanchetti A. Management of hypertension in patients with left ventricular hypertrophy. Curr Hypertens Rep, 2007, 9(6): 498-505.
19. 陈丽华. 苯磺酸左旋氨氯地平联合贝那普利治疗原发性高血压对左室肥厚的影响. 中国医学创新, 2010, 7(23): 63-64.
20. Kannel WB. Left ventricular hypertrophy as a risk factor: the Framingham experience. J Hypertens Suppl, 1991, 9(2): S3-8.
21. Devereux RB, Wachtell K, Gerdts E, et al. Prognostic Significance of Left Ventricular Mass Change During Treatment of Hypertension. JAMA, 2004, 292(19): 2350-2356.
22. 景晓娟, 艾永飞, 侯晓玲, 等. 优化联合降压治疗对高血压左室肥厚患者左室重量指数及血清瘦素水平的影响. 现代生物医学进展, 2009, 9(8): 1478-1480.
23. Neutel JM, Smith HG, Weber MA. Effects of Antihypertensive Monotherapy and Combination Therapy on Arterial Distensibility and Left Ventricular Mass. AJH, 2004, 17(1): 37-42.
24. De Rosa ML, Maddaluno G, Lionetti F, et al. Effects of enalapril and isradipine alone and in combination on blood pressure, renal function and echocardiographic parameters in mild hypertension. Int J Cardiol, 2000, 74(1): 77-84.

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Effects of Calcium Channel Blockers and Angiotensin Converting Enzyme Inhibitors on the Left Ventricular Hypertrophy in Chinese Hypertensive Patients: A Systematic Review

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