Efficacy of Amlodipine for Diabetes Mellitus Combined with Hypertension and Renal Impairment: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 HUQian-pei , LIYi-mei , JIANGLian , LUOTian-yong , HANLin-na , LIQiong ,  XIEBo

Department of General Practice, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402106, China;

Corresponding author：

XIEBo, Email: 744408027@qq.com

Keywords：

Amlodipine; Valsartan; Diabetes mellitus; Hypertension; Renal impairment; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140199

Video：

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Objective To systematically review the efficacy of amlodipine versus valsartan in the treatment of diabetes mellitus combined with hypertension and renal impairment. Methods All relevant randomized controlled trials (RCTs) were retrieved in WanFang Data, CNKI, VIP, CBM, The Cochrane Library (Issue 10, 2013), PubMed, EMbase and Ovid up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results Nine RCTs were finally included involving 794 cases. The results of meta-analysis showed that amlodipine was better than valsartan in improving 24-hour proteinuria (basic level < 1 000 mg:WMD=-10.24, 95%CI-18.52 to-1.95, P=0.02; basic level > 1 000 mg:WMD=-575.69, 95%CI-781.02 to-370.36, P < 0.000 01). However, there was no significant difference between two groups in lowing urine albumin excretion rates (UAER), serum creatinine (Scr), systolic blood pressure (SBP), diastolic blood pressure (DBP), and incidences of adverse events (UAER:WMD=-11.29, 95%CI-27.93 to 5.36, P=0.18; Scr:WMD=1.05, 95%CI-3.89 to 5.99, P=0.68; SBP:WMD=0.52, 95%CI-0.83 to 1.87, P=0.45; DBP:WMD=-0.40, 95%CI-1.41 to 0.62, P=0.44; ADR:WMD=1.00, 95%CI 0.3 to 3.34, P=1.00). Conclusion Current evidence shows that, compared with valsartan, amlodipine has the same efficacy in treatment of diabetes mellitus combined with hypertension and renal impairment, and it is even better in improving 24-hour proteinuria.

Citation： HUQian-pei, LIYi-mei, JIANGLian, LUOTian-yong, HANLin-na, LIQiong, XIEBo. Efficacy of Amlodipine for Diabetes Mellitus Combined with Hypertension and Renal Impairment: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(10): 1234-1240. doi: 10.7507/1672-2531.20140199 Copy

1.	李舍予, 李芸, 周方励, 等.四川大学华西医院内分泌代谢科2011年糖尿病住院患者费用情况调查.中国循证医学杂志, 2013, 13(10):1180-1184.
2.	Suckling R, Gallagher H. Chronic kidney disease, diabetes mellitus and cardiovascular disease:risks and commonalities. J Ren Care, 2012, 38(Suppl 1):4-11.
3.	Viberti G, Wheeldon NM. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus:a blood pressure-independent effect. Circulation, 2002, 106(6):672-678.
4.	毕研贞, 陈秋, 朱玉霞.左旋氨氯地平与缬沙坦治疗糖尿病肾病合并高血压的疗效观察.中国基层医药, 2007, 14(3):356-357.
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6.	卫生部疾病控制司, 中华医学会糖尿病学分会.中国糖尿病防治指南.中国慢性病预防与控制, 2004, 12(6):283-285.
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8.	中国高血压防治指南修订委员会. 2004年中国高血压防治指南(实用本).中华心血管病杂志, 2004, 32(12):1060-1064.
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12.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5(1):1-10.
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14.	叶德建.缬沙坦联合氨氯地平治疗糖尿病肾病合并高血压的疗效观察.实用心脑肺血管病杂志, 2013, 10(10):62-63.
15.	牛连英, 张丽娜, 赵晓静.左旋氨氯地平联合缬沙坦治疗老年高血压合并2型糖尿病32例.中国药业, 2013, 22(17):79-81.
16.	陈汉华.缬沙坦与氨氯地平用于老年高血压合并2型糖尿病的疗效观察.临床合理用药杂志, 2012, 5(8):61-62.
17.	于建敏, 陈晓星, 何云, 等.缬沙坦联合氨氯地平治疗糖尿病合并高血压病效果观察.临床误诊误治, 2009, 22(6):1-3.
18.	邓少雄, 郭南鸥.缬沙坦与氨氯地平治疗高血压病伴糖尿病临床分析.中国心血管病研究杂志, 2004, 2(10):781-783.
19.	吴欣, 洪江淮, 郑京, 等.缬沙坦、洛丁新与络活喜治疗85例糖尿病肾病的疗效比较.福建医药杂志, 2003, 25(1):122-124.
20.	Yilmaz MI, Carrero JJ, Martin-Ventura JL, et al. Combined therapy with renin-angiotensin system and calcium channel blockers in type 2 diabetic hypertensive patients with proteinuria:effects on soluble TWEAK, PTX3, and flow-mediated dilation. Clin J Am Soc Nephrol, 2010, 5(7):1174-1181.
21.	Siragy HM. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitors or calcium channel blocker vs diuretic:the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA, 2003, 5(4):293-294.
22.	Lo M, Liu K L, Lantelme P, et al. Subtype 2 of angiotensin Ⅱ receptors controls pressure-natriuresis in rats. J Clin Invest, 1995, 95(3):1394-1397.
23.	Klahr S, Morrissey J. Angiotensin Ⅱ and gene expression in the kidney. Am J Kidney Dis, 1998, 31(1):171-176.
24.	戴彤, 张抒扬.缬沙坦/氨氯地平单片复方制剂在高血压治疗中的应用.中华高血压杂志, 2011, 19(9):183-185.
25.	卢寅辉, 唐琼珍, 曹平良, 等.氨氯地平和依那普利对合并高血压的糖尿病患者肾脏保护的比较.实用临床医药杂志, 2012, 16(11):88-90.
26.	郭冀珍, 林伯贤.钙通道阻滞剂抗系膜增殖在肾脏保护作用中的地位.国外医学(内科学分册), 1999(10):420-424.
27.	Shultz PJ, Raij L. Effect of amlodipine on mesangial cell proliferation and protein synthesis. Am J Hypertens, 1992, 5(12):912-914.
28.	中国全科医学编辑部.长效二氢吡啶类钙通道阻滞剂在慢性肾脏病高血压中应用的专家共识.中国全科医学, 2006(20):1698.
29.	于欢, 陈忻, 翟所迪.左旋氨氯地平对原发性高血压患者肾功能保护作用的Meta分析.中国药房, 2011(36):3433-3437.
30.	张秋宁, 张质钢, 王小虎.国内系统评价纳入标准对随机试验的界定差异有可能导致偏倚.中国循证医学杂志, 2013, 13(6):764-767.

1. 李舍予, 李芸, 周方励, 等.四川大学华西医院内分泌代谢科2011年糖尿病住院患者费用情况调查.中国循证医学杂志, 2013, 13(10):1180-1184.
2. Suckling R, Gallagher H. Chronic kidney disease, diabetes mellitus and cardiovascular disease:risks and commonalities. J Ren Care, 2012, 38(Suppl 1):4-11.
3. Viberti G, Wheeldon NM. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus:a blood pressure-independent effect. Circulation, 2002, 106(6):672-678.
4. 毕研贞, 陈秋, 朱玉霞.左旋氨氯地平与缬沙坦治疗糖尿病肾病合并高血压的疗效观察.中国基层医药, 2007, 14(3):356-357.
5. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus:Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 1997, 20(7):1183-1197.
6. 卫生部疾病控制司, 中华医学会糖尿病学分会.中国糖尿病防治指南.中国慢性病预防与控制, 2004, 12(6):283-285.
7. Consultation W. Definition, diagnosis and classification of diabetes mellitus and its complications. World Health Organization, 1999, 31(3):1-59.
8. 中国高血压防治指南修订委员会. 2004年中国高血压防治指南(实用本).中华心血管病杂志, 2004, 32(12):1060-1064.
9. Guidelines S. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens, 1999, 17(2):151-183.
10. 陆再英, 钟南山, 主编.内科学.第7版:糖尿病.北京:人民卫生出版社, 2008:770-793.
11. 陆再英, 钟南山, 主编.内科学.第7版:高血压.北京:人民卫生出版社, 2008:251-266.
12. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5(1):1-10.
13. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).[Cited 2012 Jan 5]. Available at:http://www.cochrane-handbook.org.
14. 叶德建.缬沙坦联合氨氯地平治疗糖尿病肾病合并高血压的疗效观察.实用心脑肺血管病杂志, 2013, 10(10):62-63.
15. 牛连英, 张丽娜, 赵晓静.左旋氨氯地平联合缬沙坦治疗老年高血压合并2型糖尿病32例.中国药业, 2013, 22(17):79-81.
16. 陈汉华.缬沙坦与氨氯地平用于老年高血压合并2型糖尿病的疗效观察.临床合理用药杂志, 2012, 5(8):61-62.
17. 于建敏, 陈晓星, 何云, 等.缬沙坦联合氨氯地平治疗糖尿病合并高血压病效果观察.临床误诊误治, 2009, 22(6):1-3.
18. 邓少雄, 郭南鸥.缬沙坦与氨氯地平治疗高血压病伴糖尿病临床分析.中国心血管病研究杂志, 2004, 2(10):781-783.
19. 吴欣, 洪江淮, 郑京, 等.缬沙坦、洛丁新与络活喜治疗85例糖尿病肾病的疗效比较.福建医药杂志, 2003, 25(1):122-124.
20. Yilmaz MI, Carrero JJ, Martin-Ventura JL, et al. Combined therapy with renin-angiotensin system and calcium channel blockers in type 2 diabetic hypertensive patients with proteinuria:effects on soluble TWEAK, PTX3, and flow-mediated dilation. Clin J Am Soc Nephrol, 2010, 5(7):1174-1181.
21. Siragy HM. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitors or calcium channel blocker vs diuretic:the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA, 2003, 5(4):293-294.
22. Lo M, Liu K L, Lantelme P, et al. Subtype 2 of angiotensin Ⅱ receptors controls pressure-natriuresis in rats. J Clin Invest, 1995, 95(3):1394-1397.
23. Klahr S, Morrissey J. Angiotensin Ⅱ and gene expression in the kidney. Am J Kidney Dis, 1998, 31(1):171-176.
24. 戴彤, 张抒扬.缬沙坦/氨氯地平单片复方制剂在高血压治疗中的应用.中华高血压杂志, 2011, 19(9):183-185.
25. 卢寅辉, 唐琼珍, 曹平良, 等.氨氯地平和依那普利对合并高血压的糖尿病患者肾脏保护的比较.实用临床医药杂志, 2012, 16(11):88-90.
26. 郭冀珍, 林伯贤.钙通道阻滞剂抗系膜增殖在肾脏保护作用中的地位.国外医学(内科学分册), 1999(10):420-424.
27. Shultz PJ, Raij L. Effect of amlodipine on mesangial cell proliferation and protein synthesis. Am J Hypertens, 1992, 5(12):912-914.
28. 中国全科医学编辑部.长效二氢吡啶类钙通道阻滞剂在慢性肾脏病高血压中应用的专家共识.中国全科医学, 2006(20):1698.
29. 于欢, 陈忻, 翟所迪.左旋氨氯地平对原发性高血压患者肾功能保护作用的Meta分析.中国药房, 2011(36):3433-3437.
30. 张秋宁, 张质钢, 王小虎.国内系统评价纳入标准对随机试验的界定差异有可能导致偏倚.中国循证医学杂志, 2013, 13(6):764-767.

Chinese Journal of Evidence-Based Medicine

Efficacy of Amlodipine for Diabetes Mellitus Combined with Hypertension and Renal Impairment: A Systematic Review

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