Effect of renin-angiotensin system blockade
on calcium channel blocker-associated peripheral edema
Makani H et al. Am J Med. 2011;124:128-135,
METHOD:
•
A MEDLINE/COCHRANE search for randomised controlled trials
(RCT) in patients with hypertension, comparing calcium channel
blocker (CCB) monotherapy with CCB/renin angiotensin system
blocker combination conducted from 1980.
• RCTs reporting the incidence of peripheral edema or withdrawal of
patients because of edema and total sample size more than 100
were included in this analysis.
• 25 RCTs with 17,206 patients (mean age 56 years, 55% were men)
and a mean duration of 9.2 weeks.
.
Percentage
Combining RAAS inhibitors with CCB decreases edema
incidence/withdrawal rates with CCB
CCB = calcium channel blocker; RAS = renin-angiotensin system
*p<0.0001
Makani H et al. Am J Med. 2011;124:128-135
ACE inhibitors are more efficacious than ARBs in
reducing CCB-associated edema
P=0.0001
P<0.00001
Makani H et al. Am J Med. 2011;124:128-135
Clinical significance
• The combination of RAAS inhibitors with calcium
channel blockers (CCB) reduces the incidence by
38% and withdrawal rate due to peripheral edema by
62% when compared with calcium channel blocker
monotherapy.
• ACE inhibitors were significantly more efficacious than
ARBs in reducing the incidence of CCB-associated
peripheral edema by 54% and 24%, respectively
(P<0.0001),
• Aliskiren did not show significant reduction of
CCB-associated cough.
Makani H et al. Am J Med. 2011;124:128-135.