Document Detail

Amlodipine and angiotensin-converting enzyme inhibitor combination versus amlodipine monotherapy in hypertension: a meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  20512032     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study aimed to estimate the efficacy and tolerability of the combination of amlodipine and angiotensin-converting enzyme inhibitors as compared with amlodipine monotherapy in the treatment of hypertension. METHODS: The Cochrane Central Register of Controlled Trials, PubMed, and Embase were searched for relevant articles. A random effect model of meta-analysis was used for the selected randomized controlled trials (RCTs). RESULTS: A total of 17 randomized controlled trials involving 3291 patients were identified using predefined criteria. The combination treatment of amlodipine and angiotensin-converting enzyme inhibitors resulted in a greater reduction of both systolic blood pressure (SBP) [weighted mean difference (WMD) 5.72, 95% CI: (confidence interval) 4.10-7.33] and diastolic blood pressure (DBP) (WMD 3.62, 95% CI: 4.85-2.39) than monotherapy. The combination treatment also generated significantly greater reductions for the mean ambulatory SBP and DBP during the full 24 hours (WMD: SBP 4.24, 95% CI: 6.82-1.67; DBP 2.23, 95% CI: 3.73-0.69), but not for the trough (WMD: SBP 4.52, 9.56 to -0.51; DBP 3.7, 7.65 to -0.25). The hypertension therapeutic control (SPB <140, DBP <90 mmHg) rate for the combination treatment is higher than that for monotherapy [relative risk (RR): 1.36, 95% CI: 1.07-1.73]. The combination treatment also resulted in a lower overall rate of adverse events (RR: 0.86, 95% CI: 0.75-0.99) and edema (RR: 0.40, 95% CI: 0.29-0.56), but a higher rate of cough (RR: 3.28, 95% CI: 2.03-5.29) as compared with monotherapy. CONCLUSION: This meta-analysis suggests that the combination treatment provides superior BP control, fewer adverse events, and better tolerability in hypertensive patients than monotherapy. Further research should explore the mechanism of the combination therapy and whether it is associated with the reduction of cardiovascular disease morbidity and mortality.
Yan Lv; Zui Zou; Guan-min Chen; Huai-Xin Jia; Jing Zhong; Wei-Wu Fang
Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Blood pressure monitoring     Volume:  15     ISSN:  1473-5725     ISO Abbreviation:  Blood Press Monit     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-14     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9606438     Medline TA:  Blood Press Monit     Country:  England    
Other Details:
Languages:  eng     Pagination:  195-204     Citation Subset:  IM    
Department of Anesthesiology, Military Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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MeSH Terms
Amlodipine / administration & dosage*,  adverse effects
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Antihypertensive Agents / administration & dosage*
Calcium Channel Blockers / administration & dosage*,  adverse effects
Drug Therapy, Combination
Hypertension / drug therapy*
Middle Aged
Randomized Controlled Trials as Topic
Sensitivity and Specificity
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 88150-42-9/Amlodipine

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