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, 李蕓, 周方勵, 等.四川大學華西醫院內分泌代謝科2011年糖尿病住院患者費用情況調查.中國循證醫學雜志, 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.	畢研貞, 陳秋, 朱玉霞.左旋氨氯地平與纈沙坦治療糖尿病腎病合并高血壓的療效觀察.中國基層醫藥, 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.	衛生部疾病控制司, 中華醫學會糖尿病學分會.中國糖尿病防治指南.中國慢性病預防與控制, 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.	中國高血壓防治指南修訂委員會. 2004年中國高血壓防治指南(實用本).中華心血管病雜志, 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.	陸再英, 鐘南山, 主編.內科學.第7版:糖尿病.北京:人民衛生出版社, 2008:770-793.
11.	陸再英, 鐘南山, 主編.內科學.第7版:高血壓.北京:人民衛生出版社, 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.	葉德建.纈沙坦聯合氨氯地平治療糖尿病腎病合并高血壓的療效觀察.實用心腦肺血管病雜志, 2013, 10(10):62-63.
15.	牛連英, 張麗娜, 趙曉靜.左旋氨氯地平聯合纈沙坦治療老年高血壓合并2型糖尿病32例.中國藥業, 2013, 22(17):79-81.
16.	陳漢華.纈沙坦與氨氯地平用于老年高血壓合并2型糖尿病的療效觀察.臨床合理用藥雜志, 2012, 5(8):61-62.
17.	于建敏, 陳曉星, 何云, 等.纈沙坦聯合氨氯地平治療糖尿病合并高血壓病效果觀察.臨床誤診誤治, 2009, 22(6):1-3.
18.	鄧少雄, 郭南鷗.纈沙坦與氨氯地平治療高血壓病伴糖尿病臨床分析.中國心血管病研究雜志, 2004, 2(10):781-783.
19.	吳欣, 洪江淮, 鄭京, 等.纈沙坦、洛丁新與絡活喜治療85例糖尿病腎病的療效比較.福建醫藥雜志, 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, 張抒揚.纈沙坦/氨氯地平單片復方制劑在高血壓治療中的應用.中華高血壓雜志, 2011, 19(9):183-185.
25.	盧寅輝, 唐瓊珍, 曹平良, 等.氨氯地平和依那普利對合并高血壓的糖尿病患者腎臟保護的比較.實用臨床醫藥雜志, 2012, 16(11):88-90.
26.	郭冀珍, 林伯賢.鈣通道阻滯劑抗系膜增殖在腎臟保護作用中的地位.國外醫學(內科學分冊), 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.	中國全科醫學編輯部.長效二氫吡啶類鈣通道阻滯劑在慢性腎臟病高血壓中應用的專家共識.中國全科醫學, 2006(20):1698.
29.	于歡, 陳忻, 翟所迪.左旋氨氯地平對原發性高血壓患者腎功能保護作用的Meta分析.中國藥房, 2011(36):3433-3437.
30.	張秋寧, 張質鋼, 王小虎.國內系統評價納入標準對隨機試驗的界定差異有可能導致偏倚.中國循證醫學雜志, 2013, 13(6):764-767.

1. 李舍予, 李蕓, 周方勵, 等.四川大學華西醫院內分泌代謝科2011年糖尿病住院患者費用情況調查.中國循證醫學雜志, 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. 畢研貞, 陳秋, 朱玉霞.左旋氨氯地平與纈沙坦治療糖尿病腎病合并高血壓的療效觀察.中國基層醫藥, 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. 衛生部疾病控制司, 中華醫學會糖尿病學分會.中國糖尿病防治指南.中國慢性病預防與控制, 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. 中國高血壓防治指南修訂委員會. 2004年中國高血壓防治指南(實用本).中華心血管病雜志, 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. 陸再英, 鐘南山, 主編.內科學.第7版:糖尿病.北京:人民衛生出版社, 2008:770-793.
11. 陸再英, 鐘南山, 主編.內科學.第7版:高血壓.北京:人民衛生出版社, 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. 葉德建.纈沙坦聯合氨氯地平治療糖尿病腎病合并高血壓的療效觀察.實用心腦肺血管病雜志, 2013, 10(10):62-63.
15. 牛連英, 張麗娜, 趙曉靜.左旋氨氯地平聯合纈沙坦治療老年高血壓合并2型糖尿病32例.中國藥業, 2013, 22(17):79-81.
16. 陳漢華.纈沙坦與氨氯地平用于老年高血壓合并2型糖尿病的療效觀察.臨床合理用藥雜志, 2012, 5(8):61-62.
17. 于建敏, 陳曉星, 何云, 等.纈沙坦聯合氨氯地平治療糖尿病合并高血壓病效果觀察.臨床誤診誤治, 2009, 22(6):1-3.
18. 鄧少雄, 郭南鷗.纈沙坦與氨氯地平治療高血壓病伴糖尿病臨床分析.中國心血管病研究雜志, 2004, 2(10):781-783.
19. 吳欣, 洪江淮, 鄭京, 等.纈沙坦、洛丁新與絡活喜治療85例糖尿病腎病的療效比較.福建醫藥雜志, 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, 張抒揚.纈沙坦/氨氯地平單片復方制劑在高血壓治療中的應用.中華高血壓雜志, 2011, 19(9):183-185.
25. 盧寅輝, 唐瓊珍, 曹平良, 等.氨氯地平和依那普利對合并高血壓的糖尿病患者腎臟保護的比較.實用臨床醫藥雜志, 2012, 16(11):88-90.
26. 郭冀珍, 林伯賢.鈣通道阻滯劑抗系膜增殖在腎臟保護作用中的地位.國外醫學(內科學分冊), 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. 中國全科醫學編輯部.長效二氫吡啶類鈣通道阻滯劑在慢性腎臟病高血壓中應用的專家共識.中國全科醫學, 2006(20):1698.
29. 于歡, 陳忻, 翟所迪.左旋氨氯地平對原發性高血壓患者腎功能保護作用的Meta分析.中國藥房, 2011(36):3433-3437.
30. 張秋寧, 張質鋼, 王小虎.國內系統評價納入標準對隨機試驗的界定差異有可能導致偏倚.中國循證醫學雜志, 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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