Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SHAO Zhimin ^1,2 , CHEN Yan ^1,2 , ZHANG Wanjun ^1,2 ,  YAO Yingshui ^1,2

1. Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, 241002, P.R.China;
2. Institute of Chronic Disease Prevention and Control, Wannan Medical College, Wuhu, 241002, P.R.China;

Corresponding author：

YAO Yingshui, Email: yingshuiyao@163.com

Keywords：

Nifedipine; Atorvastatin; Hypertension; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201902076

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the influence of nifedipine combined with atorvastatin on hypertension in patients with hypertension.Method PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of nifedipine combined with atorvastatin on hypertension in patients with hypertension from inception to November 20^th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.Results A total of 17 RCTs involving 1 838 patients were included. The results of meta-analysis indicated that nifedipine combined with atorvastatin was superior to nifedipine alone on SBP (MD=−8.937, 95%CI−11.913 to −5.962, P<0.001), DBP (MD=−3.702, 95%CI−6.626 to −0.778, P=0.013) and total effective rate (RR=1.24, 95%CI 1.07 to 1.44, P=0.003). There was no significant difference between two groups in the incidence of adverse reactions (P>0.05).Conclusions Current evidence shows that nifedipine combined with atorvastatin can significantly improve total effective rate, decrease the level of SBP and DBP, and increasing of dose not increase the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： SHAO Zhimin, CHEN Yan, ZHANG Wanjun, YAO Yingshui. Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 932-938. doi: 10.7507/1672-2531.201902076 Copy

1.	马丽媛, 吴亚哲, 王文, 等. 《中国心血管病报告2017》要点解读. 中国心血管杂志, 2018, 23(1): 3-6.
2.	Watanabe Y, Inaba T, Shimano H, et al. Effect of macrophage colony stimulating factor on the, advanced atherosclerosis in watanabe heritable hyperlipidemic rabbits. Horm Metab Res, 1997, 29(10): 507-509.
3.	Jurukovska-Nospal M, Arsova V, Levchanska J, et al. Effects of statins (atorvastatin) on serum lipoprotein levels in patients with primary hyperlipidemia and coronary heart disease. Prilozi, 2007, 28(2): 137-148.
4.	刘力生. 中国高血压防治指南2010. 中国医学前沿杂志(电子版), 2011, 3(5): 42-93.
5.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
6.	云嶷, 彭新, 原芳, 等. 硝苯地平控释片联合阿托伐他汀钙治疗高血压合并冠心病的效果分析. 河南医学研究, 2018, 27(8): 1430-1431.
7.	姜一杰. 硝苯地平控释片联合阿托伐他汀钙治疗高血压合并冠心病的疗效观察. 养生保健指南, 2018, (22): 354.
8.	杨诚. 阿托伐他汀钙联合硝苯地平缓释片治疗高血压合并冠心病的临床疗效观察. 现代诊断与治疗, 2015, 26(5): 1041-1042.
9.	吴照科, 李惠勉, 李凌, 等. 硝苯地平控释片与阿托伐他汀对高血压患者颈动脉内膜中层厚度及血管内皮功能的影响. 中国循证心血管医学杂志, 2009, 1(4): 284-288.
10.	薛红, 张晔, 王旭开, 等. 阿托伐他汀与硝苯地平控释片的协同降压作用及对血管内皮功能的影响. 第三军医大学学报, 2006, 28(15): 1616-1618.
11.	刘左玲, 刘衍宇, 凌云, 等. 阿托伐他汀钙联合硝苯地平缓释片治疗轻中度高血压合并心脏病的疗效与肝肾功能影响. 中国医药科学, 2015, 5(11): 66-68.
12.	黄雪茹, 王家骥. 阿托伐他汀钙联合硝苯地平缓释片治疗老年轻中度高血压合并左心室肥厚的临床疗效及其对肝肾功能的影响. 实用心脑肺血管病杂志, 2015, 23(10): 61-63.
13.	黄桂琴. 硝苯地平控释片与阿托伐他汀对高血压患者颈动脉内膜中层厚度及血管内皮功能的影响. 内科, 2012, 7(5): 471-473.
14.	张克军, 陶涛. 阿托伐他汀钙联合硝苯地平治疗老年高血压合并心律失常的疗效及副作用. 临床医学研究与实践, 2018, 3(23): 41-44.
15.	向红菊, 潘港, 王福军, 等. 阿托伐他汀对血脂正常的老年收缩期高血压患者脉压的影响. 心血管康复医学杂志, 2007, 16(2): 160-162.
16.	苏华科, 吴莹, 甄怀蒙, 等. 阿托伐他汀联合硝苯地平控释片治疗老年高血压的疗效观察. 临床和实验医学杂志, 2012, 11(24): 1967-1968.
17.	张战国. 阿托伐他汀联合硝苯地平治疗老年单纯收缩期高血压疗效分析. 中国现代药物应用, 2009, 3(6): 127-128.
18.	李卫红, 罗晋. 硝苯地平控释片联合阿托伐他汀治疗原发性高血压102例临床研究. 实用临床医学, 2010, 11(4): 11-13.
19.	杨文仙. 阿托伐他汀钙联合硝苯地平治疗原发性高血压效果观察. 中国乡村医药, 2017, 24(2): 39-40.
20.	葛梦丹. 硝苯地平联合阿托伐他汀治疗老年高血压伴动脉硬化的临床观察与分析. 海峡药学, 2013, 25(3): 68-70.
21.	陈伟, 张亚西. 硝苯地平控释片联合阿托伐他汀治疗高血压合并冠心病及对超敏C反应蛋白及血管内皮功能的影响. 检验医学与临床, 2015, 12(1): 40-42.
22.	景占聪. 硝苯地平联合不同药物治疗老年高血压疗效分析. 中国保健营养(上旬刊), 2013, 23(8): 4556-4556.
23.	Stevens W, Peneva D, Li JZ, et al. Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China. BMC Health Serv Res, 2016, 16: 175.
24.	史琼, 郑东鹏. 血脂异常危险因素的研究进展. 上海医药, 2018, 39(20): 43-46.
25.	周凤英. 高血压和高血脂的相关性分析. 临床医药实践, 2010, 19(4): 154-156.
26.	Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Drugs, 2004, 64(Suppl 2): 43-60.
27.	赵丽丽, 罗勇. 阿托伐他汀在高血压病治疗中的研究进展. 中华临床医师杂志(电子版), 2011, 5(9): 2672-2674.
28.	Wilkinson IB, Prasad K, Hall IR, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol, 2002, 39(6): 1005-1011.
29.	Danaoğlu Z, Kültürsay H, Kayikçioğlu M, et al. Effect of statin therapy added to ACE-inhibitors on blood pressure control and endothelial functions in normolipidemic hypertensive patients. Anadolu Kardiyol Derg, 2003, 3(4): 331-337.
30.	Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol, 2002, 39(6): 1020-1025.
31.	Wassmann S, Laufs U, Baumer A T, et al. HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species. Hypertension, 2001, 37(6): 1450-1457.
32.	盛臻强, 卢辉和, 黎叶飞, 等. 早期强化阿托伐他汀治疗对不稳定性心绞痛患者NO、ET-1水平的影响. 南通大学学报(医学版), 2012, 32(6): 474-476.
33.	Widyantoro B, Emoto N, Nakayama K, et al. Endothelial cell-derived endothelin-1 promotes cardiac fibrosis in diabetic hearts through stimulation of endothelial-to-mesenchymal transition. Circulation, 2010, 121(22): 2407-2418.
34.	Laufs U, Gertz K, Dirnagl U, et al. Rosuvastatin, a new HMG-CoA reductase inhibitor, upregulates endothelial nitric oxide synthase and protects from ischemic stroke in mice. Brain Res, 2002, 942(1-2): 23-30.
35.	Chae CU, Lee RT, Rifai N, et al. Blood pressure and inflammation in apparently healthy men. Hypertension, 2001, 38(3): 399-403.
36.	Ziegelhöffer A, Mujkošová J, Ferko M, et al. Dual influence of spontaneous hypertension on membrane properties and ATP production in heart and kidney mitochondria in rat: effect of captopril and nifedipine, adaptation and dysadaptation. Can J Physiol Pharmacol, 2012, 90(9): 1311-1323.
37.	ENCORE Investigators. Effect of nifedipine and cerivastatin on coronary endothelial function in patients with coronary artery disease: the ENCORE I Study (evaluation of nifedipine and cerivastatin on recovery of coronary endothelial function). Circulation, 2003, 107(3): 422-428.
38.	Azushima K, Uneda K, Tamura K, et al. Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease. Biomed Res Int, 2014, 2014: 437087.
39.	Chapman RH, Yeaw J, Roberts CS. Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees. BMC Cardiovasc Disord, 2010, 10: 29.
40.	Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension. Int J Cardiol, 2011, 146(3): 319-325.
41.	Delgado-Montero A, Zamorano JL. Atorvastatin calcium plus amlodipine for the treatment of hypertension. Expert Opin Pharmacother, 2012, 13(18): 2673-2685.

1. 马丽媛, 吴亚哲, 王文, 等. 《中国心血管病报告2017》要点解读. 中国心血管杂志, 2018, 23(1): 3-6.
2. Watanabe Y, Inaba T, Shimano H, et al. Effect of macrophage colony stimulating factor on the, advanced atherosclerosis in watanabe heritable hyperlipidemic rabbits. Horm Metab Res, 1997, 29(10): 507-509.
3. Jurukovska-Nospal M, Arsova V, Levchanska J, et al. Effects of statins (atorvastatin) on serum lipoprotein levels in patients with primary hyperlipidemia and coronary heart disease. Prilozi, 2007, 28(2): 137-148.
4. 刘力生. 中国高血压防治指南2010. 中国医学前沿杂志(电子版), 2011, 3(5): 42-93.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
6. 云嶷, 彭新, 原芳, 等. 硝苯地平控释片联合阿托伐他汀钙治疗高血压合并冠心病的效果分析. 河南医学研究, 2018, 27(8): 1430-1431.
7. 姜一杰. 硝苯地平控释片联合阿托伐他汀钙治疗高血压合并冠心病的疗效观察. 养生保健指南, 2018, (22): 354.
8. 杨诚. 阿托伐他汀钙联合硝苯地平缓释片治疗高血压合并冠心病的临床疗效观察. 现代诊断与治疗, 2015, 26(5): 1041-1042.
9. 吴照科, 李惠勉, 李凌, 等. 硝苯地平控释片与阿托伐他汀对高血压患者颈动脉内膜中层厚度及血管内皮功能的影响. 中国循证心血管医学杂志, 2009, 1(4): 284-288.
10. 薛红, 张晔, 王旭开, 等. 阿托伐他汀与硝苯地平控释片的协同降压作用及对血管内皮功能的影响. 第三军医大学学报, 2006, 28(15): 1616-1618.
11. 刘左玲, 刘衍宇, 凌云, 等. 阿托伐他汀钙联合硝苯地平缓释片治疗轻中度高血压合并心脏病的疗效与肝肾功能影响. 中国医药科学, 2015, 5(11): 66-68.
12. 黄雪茹, 王家骥. 阿托伐他汀钙联合硝苯地平缓释片治疗老年轻中度高血压合并左心室肥厚的临床疗效及其对肝肾功能的影响. 实用心脑肺血管病杂志, 2015, 23(10): 61-63.
13. 黄桂琴. 硝苯地平控释片与阿托伐他汀对高血压患者颈动脉内膜中层厚度及血管内皮功能的影响. 内科, 2012, 7(5): 471-473.
14. 张克军, 陶涛. 阿托伐他汀钙联合硝苯地平治疗老年高血压合并心律失常的疗效及副作用. 临床医学研究与实践, 2018, 3(23): 41-44.
15. 向红菊, 潘港, 王福军, 等. 阿托伐他汀对血脂正常的老年收缩期高血压患者脉压的影响. 心血管康复医学杂志, 2007, 16(2): 160-162.
16. 苏华科, 吴莹, 甄怀蒙, 等. 阿托伐他汀联合硝苯地平控释片治疗老年高血压的疗效观察. 临床和实验医学杂志, 2012, 11(24): 1967-1968.
17. 张战国. 阿托伐他汀联合硝苯地平治疗老年单纯收缩期高血压疗效分析. 中国现代药物应用, 2009, 3(6): 127-128.
18. 李卫红, 罗晋. 硝苯地平控释片联合阿托伐他汀治疗原发性高血压102例临床研究. 实用临床医学, 2010, 11(4): 11-13.
19. 杨文仙. 阿托伐他汀钙联合硝苯地平治疗原发性高血压效果观察. 中国乡村医药, 2017, 24(2): 39-40.
20. 葛梦丹. 硝苯地平联合阿托伐他汀治疗老年高血压伴动脉硬化的临床观察与分析. 海峡药学, 2013, 25(3): 68-70.
21. 陈伟, 张亚西. 硝苯地平控释片联合阿托伐他汀治疗高血压合并冠心病及对超敏C反应蛋白及血管内皮功能的影响. 检验医学与临床, 2015, 12(1): 40-42.
22. 景占聪. 硝苯地平联合不同药物治疗老年高血压疗效分析. 中国保健营养(上旬刊), 2013, 23(8): 4556-4556.
23. Stevens W, Peneva D, Li JZ, et al. Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China. BMC Health Serv Res, 2016, 16: 175.
24. 史琼, 郑东鹏. 血脂异常危险因素的研究进展. 上海医药, 2018, 39(20): 43-46.
25. 周凤英. 高血压和高血脂的相关性分析. 临床医药实践, 2010, 19(4): 154-156.
26. Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Drugs, 2004, 64(Suppl 2): 43-60.
27. 赵丽丽, 罗勇. 阿托伐他汀在高血压病治疗中的研究进展. 中华临床医师杂志(电子版), 2011, 5(9): 2672-2674.
28. Wilkinson IB, Prasad K, Hall IR, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol, 2002, 39(6): 1005-1011.
29. Danaoğlu Z, Kültürsay H, Kayikçioğlu M, et al. Effect of statin therapy added to ACE-inhibitors on blood pressure control and endothelial functions in normolipidemic hypertensive patients. Anadolu Kardiyol Derg, 2003, 3(4): 331-337.
30. Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol, 2002, 39(6): 1020-1025.
31. Wassmann S, Laufs U, Baumer A T, et al. HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species. Hypertension, 2001, 37(6): 1450-1457.
32. 盛臻强, 卢辉和, 黎叶飞, 等. 早期强化阿托伐他汀治疗对不稳定性心绞痛患者NO、ET-1水平的影响. 南通大学学报(医学版), 2012, 32(6): 474-476.
33. Widyantoro B, Emoto N, Nakayama K, et al. Endothelial cell-derived endothelin-1 promotes cardiac fibrosis in diabetic hearts through stimulation of endothelial-to-mesenchymal transition. Circulation, 2010, 121(22): 2407-2418.
34. Laufs U, Gertz K, Dirnagl U, et al. Rosuvastatin, a new HMG-CoA reductase inhibitor, upregulates endothelial nitric oxide synthase and protects from ischemic stroke in mice. Brain Res, 2002, 942(1-2): 23-30.
35. Chae CU, Lee RT, Rifai N, et al. Blood pressure and inflammation in apparently healthy men. Hypertension, 2001, 38(3): 399-403.
36. Ziegelhöffer A, Mujkošová J, Ferko M, et al. Dual influence of spontaneous hypertension on membrane properties and ATP production in heart and kidney mitochondria in rat: effect of captopril and nifedipine, adaptation and dysadaptation. Can J Physiol Pharmacol, 2012, 90(9): 1311-1323.
37. ENCORE Investigators. Effect of nifedipine and cerivastatin on coronary endothelial function in patients with coronary artery disease: the ENCORE I Study (evaluation of nifedipine and cerivastatin on recovery of coronary endothelial function). Circulation, 2003, 107(3): 422-428.
38. Azushima K, Uneda K, Tamura K, et al. Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease. Biomed Res Int, 2014, 2014: 437087.
39. Chapman RH, Yeaw J, Roberts CS. Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees. BMC Cardiovasc Disord, 2010, 10: 29.
40. Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension. Int J Cardiol, 2011, 146(3): 319-325.
41. Delgado-Montero A, Zamorano JL. Atorvastatin calcium plus amlodipine for the treatment of hypertension. Expert Opin Pharmacother, 2012, 13(18): 2673-2685.

Chinese Journal of Evidence-Based Medicine

Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis

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