Effect of Renin-Angiotensin System Blockade on Calcium Channel Blocker-Associated Peripheral Edema
Abstract Background Peripheral edema is a common adverse effect of calcium channel blockers. The addition of a renin-angiotensin system blocker, either an angiotensin-converting enzyme inhibitor or an ARB, has been shown to reduce peripheral edema in a dose-dependent way. Methods We performed a MEDL...
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| creator | Makani, Harikrishna, MD Bangalore, Sripal, MD, MHA Romero, Jorge, MD Wever-Pinzon, Omar, MD Messerli, Franz H., MD |
| description | Abstract Background Peripheral edema is a common adverse effect of calcium channel blockers. The addition of a renin-angiotensin system blocker, either an angiotensin-converting enzyme inhibitor or an ARB, has been shown to reduce peripheral edema in a dose-dependent way. Methods We performed a MEDLINE/COCHRANE search for all prospective randomized controlled trials in patients with hypertension, comparing calcium channel blocker monotherapy with calcium channel blocker/renin-angiotensin system blocker combination from 1980 to the present. Trials 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. Results We analyzed 25 randomized controlled trials with 17,206 patients (mean age 56 years, 55% were men) and a mean duration of 9.2 weeks. The incidence of peripheral edema with calcium channel blocker/renin-angiotensin system blocker combination was 38% lower than that with calcium channel blocker monotherapy ( P < .00001) (relative risk [RR] 0.62; 95% confidence interval [CI], 0.53-0.74). Similarly, the risk of withdrawal due to peripheral edema was 62% lower with calcium channel blocker/renin-angiotensin system blocker combination compared with calcium channel blocker monotherapy ( P = .002) (RR 0.38; 95% CI, 0.22-0.66). ACE inhibitors were significantly more efficacious than ARBs in reducing the incidence of peripheral edema ( P < .0001) (ratio of RR 0.74; 95% CI, 0.64-0.84) (indirect comparison). Conclusion In patients with hypertension, the calcium channel blocker/renin-angiotensin system blocker combination reduces the risk of calcium channel blocker-associated peripheral edema when compared with calcium channel blocker monotherapy. ACE inhibitor seems to be more efficacious than ARB in reducing calcium channel blocker-associated peripheral edema, but head-to-head comparison studies are needed to prove this. |
| doi_str_mv | 10.1016/j.amjmed.2010.08.007 |
| format | Article |
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The addition of a renin-angiotensin system blocker, either an angiotensin-converting enzyme inhibitor or an ARB, has been shown to reduce peripheral edema in a dose-dependent way. Methods We performed a MEDLINE/COCHRANE search for all prospective randomized controlled trials in patients with hypertension, comparing calcium channel blocker monotherapy with calcium channel blocker/renin-angiotensin system blocker combination from 1980 to the present. Trials 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. Results We analyzed 25 randomized controlled trials with 17,206 patients (mean age 56 years, 55% were men) and a mean duration of 9.2 weeks. The incidence of peripheral edema with calcium channel blocker/renin-angiotensin system blocker combination was 38% lower than that with calcium channel blocker monotherapy ( P < .00001) (relative risk [RR] 0.62; 95% confidence interval [CI], 0.53-0.74). Similarly, the risk of withdrawal due to peripheral edema was 62% lower with calcium channel blocker/renin-angiotensin system blocker combination compared with calcium channel blocker monotherapy ( P = .002) (RR 0.38; 95% CI, 0.22-0.66). ACE inhibitors were significantly more efficacious than ARBs in reducing the incidence of peripheral edema ( P < .0001) (ratio of RR 0.74; 95% CI, 0.64-0.84) (indirect comparison). Conclusion In patients with hypertension, the calcium channel blocker/renin-angiotensin system blocker combination reduces the risk of calcium channel blocker-associated peripheral edema when compared with calcium channel blocker monotherapy. ACE inhibitor seems to be more efficacious than ARB in reducing calcium channel blocker-associated peripheral edema, but head-to-head comparison studies are needed to prove this.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2010.08.007</identifier><identifier>PMID: 21295192</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>ACE inhibitors ; Aliskiren ; Amides - therapeutic use ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive Agents - administration & dosage ; Antihypertensive Agents - adverse effects ; ARBs ; Beta blockers ; Biological and medical sciences ; Calcium ; Calcium channel blockers ; Calcium Channel Blockers - administration & dosage ; Calcium Channel Blockers - adverse effects ; Clinical trials ; Drug Therapy, Combination ; Edema - chemically induced ; Edema - prevention & control ; Female ; Fumarates - therapeutic use ; General aspects ; Humans ; Hypertension ; Hypertension - drug therapy ; Incidence ; Internal Medicine ; Male ; Medical sciences ; Meta-analysis ; Middle Aged ; Peripheral edema ; Randomized Controlled Trials as Topic ; Renin - antagonists & inhibitors ; Renin-Angiotensin System - drug effects ; Research Design ; Side effects ; Treatment Refusal</subject><ispartof>The American journal of medicine, 2011-02, Vol.124 (2), p.128-135</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Feb 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c571t-e23ad4e02b290599cc7be989b57a086f44b3216e6ed2931a469430df514c77bf3</citedby><cites>FETCH-LOGICAL-c571t-e23ad4e02b290599cc7be989b57a086f44b3216e6ed2931a469430df514c77bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjmed.2010.08.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23877132$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21295192$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Makani, Harikrishna, MD</creatorcontrib><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><creatorcontrib>Romero, Jorge, MD</creatorcontrib><creatorcontrib>Wever-Pinzon, Omar, MD</creatorcontrib><creatorcontrib>Messerli, Franz H., MD</creatorcontrib><title>Effect of Renin-Angiotensin System Blockade on Calcium Channel Blocker-Associated Peripheral Edema</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background Peripheral edema is a common adverse effect of calcium channel blockers. The addition of a renin-angiotensin system blocker, either an angiotensin-converting enzyme inhibitor or an ARB, has been shown to reduce peripheral edema in a dose-dependent way. Methods We performed a MEDLINE/COCHRANE search for all prospective randomized controlled trials in patients with hypertension, comparing calcium channel blocker monotherapy with calcium channel blocker/renin-angiotensin system blocker combination from 1980 to the present. Trials 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. Results We analyzed 25 randomized controlled trials with 17,206 patients (mean age 56 years, 55% were men) and a mean duration of 9.2 weeks. The incidence of peripheral edema with calcium channel blocker/renin-angiotensin system blocker combination was 38% lower than that with calcium channel blocker monotherapy ( P < .00001) (relative risk [RR] 0.62; 95% confidence interval [CI], 0.53-0.74). Similarly, the risk of withdrawal due to peripheral edema was 62% lower with calcium channel blocker/renin-angiotensin system blocker combination compared with calcium channel blocker monotherapy ( P = .002) (RR 0.38; 95% CI, 0.22-0.66). ACE inhibitors were significantly more efficacious than ARBs in reducing the incidence of peripheral edema ( P < .0001) (ratio of RR 0.74; 95% CI, 0.64-0.84) (indirect comparison). Conclusion In patients with hypertension, the calcium channel blocker/renin-angiotensin system blocker combination reduces the risk of calcium channel blocker-associated peripheral edema when compared with calcium channel blocker monotherapy. ACE inhibitor seems to be more efficacious than ARB in reducing calcium channel blocker-associated peripheral edema, but head-to-head comparison studies are needed to prove this.</description><subject>ACE inhibitors</subject><subject>Aliskiren</subject><subject>Amides - therapeutic use</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Antihypertensive Agents - administration & dosage</subject><subject>Antihypertensive Agents - adverse effects</subject><subject>ARBs</subject><subject>Beta blockers</subject><subject>Biological and medical sciences</subject><subject>Calcium</subject><subject>Calcium channel blockers</subject><subject>Calcium Channel Blockers - administration & dosage</subject><subject>Calcium Channel Blockers - adverse effects</subject><subject>Clinical trials</subject><subject>Drug Therapy, Combination</subject><subject>Edema - chemically induced</subject><subject>Edema - prevention & control</subject><subject>Female</subject><subject>Fumarates - therapeutic use</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Peripheral edema</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Renin - antagonists & inhibitors</subject><subject>Renin-Angiotensin System - drug effects</subject><subject>Research Design</subject><subject>Side effects</subject><subject>Treatment Refusal</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2L1DAUhoMo7uzqPxApgnjVMZ9NcyOMw6wKC4qr4F1I01M3s20ym7TC_HtTOquwN3uVj_OcN-fkPQi9InhNMKne79dm2A_QrinOV7heYyyfoBURQpSSVPQpWmGMaakYZ2foPKV9PmIlqufojBKqBFF0hZpd14Edi9AV38E7X278bxdG8Mn54vqYRhiKj32wt6aFIvhia3rrpqHY3hjvoV9iEMtNSsE6M0JbfIPoDjcQTV_sWhjMC_SsM32Cl6f1Av283P3Yfi6vvn76st1clVZIMpZAmWk5YNpQhYVS1soGVK0aIQ2uq47zhlFSQQUtVYwYXinOcNsJwq2UTccu0LtF9xDD3QRp1INLFvreeAhT0krwCkuVkx8ja4GFqBUnmXzzgNyHKfrcRoZ4LoMJliG-QDaGlCJ0-hDdYOJRE6xnr_ReL17p2SuNa529ymmvT9pTM8fuk-7NycDbE2CSNX0Xjbcu_edYLSVhM_dh4SD_7h8HUSfrwFtoXcze6ja4xyp5KGB7511-8xaOkP61THSiGuvrea7msSJ5I7n4xf4CrWXG3Q</recordid><startdate>20110201</startdate><enddate>20110201</enddate><creator>Makani, Harikrishna, MD</creator><creator>Bangalore, Sripal, MD, MHA</creator><creator>Romero, Jorge, MD</creator><creator>Wever-Pinzon, Omar, MD</creator><creator>Messerli, Franz H., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Sequoia S.A</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7QP</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20110201</creationdate><title>Effect of Renin-Angiotensin System Blockade on Calcium Channel Blocker-Associated Peripheral Edema</title><author>Makani, Harikrishna, MD ; Bangalore, Sripal, MD, MHA ; Romero, Jorge, MD ; Wever-Pinzon, Omar, MD ; Messerli, Franz H., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c571t-e23ad4e02b290599cc7be989b57a086f44b3216e6ed2931a469430df514c77bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>ACE inhibitors</topic><topic>Aliskiren</topic><topic>Amides - therapeutic use</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Antihypertensive Agents - administration & dosage</topic><topic>Antihypertensive Agents - adverse effects</topic><topic>ARBs</topic><topic>Beta blockers</topic><topic>Biological and medical sciences</topic><topic>Calcium</topic><topic>Calcium channel blockers</topic><topic>Calcium Channel Blockers - administration & dosage</topic><topic>Calcium Channel Blockers - adverse effects</topic><topic>Clinical trials</topic><topic>Drug Therapy, Combination</topic><topic>Edema - chemically induced</topic><topic>Edema - prevention & control</topic><topic>Female</topic><topic>Fumarates - therapeutic use</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Peripheral edema</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Renin - antagonists & inhibitors</topic><topic>Renin-Angiotensin System - drug effects</topic><topic>Research Design</topic><topic>Side effects</topic><topic>Treatment Refusal</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Makani, Harikrishna, MD</creatorcontrib><creatorcontrib>Bangalore, Sripal, MD, MHA</creatorcontrib><creatorcontrib>Romero, Jorge, MD</creatorcontrib><creatorcontrib>Wever-Pinzon, Omar, MD</creatorcontrib><creatorcontrib>Messerli, Franz H., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Makani, Harikrishna, MD</au><au>Bangalore, Sripal, MD, MHA</au><au>Romero, Jorge, MD</au><au>Wever-Pinzon, Omar, MD</au><au>Messerli, Franz H., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Renin-Angiotensin System Blockade on Calcium Channel Blocker-Associated Peripheral Edema</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2011-02-01</date><risdate>2011</risdate><volume>124</volume><issue>2</issue><spage>128</spage><epage>135</epage><pages>128-135</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background Peripheral edema is a common adverse effect of calcium channel blockers. The addition of a renin-angiotensin system blocker, either an angiotensin-converting enzyme inhibitor or an ARB, has been shown to reduce peripheral edema in a dose-dependent way. Methods We performed a MEDLINE/COCHRANE search for all prospective randomized controlled trials in patients with hypertension, comparing calcium channel blocker monotherapy with calcium channel blocker/renin-angiotensin system blocker combination from 1980 to the present. Trials 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. Results We analyzed 25 randomized controlled trials with 17,206 patients (mean age 56 years, 55% were men) and a mean duration of 9.2 weeks. The incidence of peripheral edema with calcium channel blocker/renin-angiotensin system blocker combination was 38% lower than that with calcium channel blocker monotherapy ( P < .00001) (relative risk [RR] 0.62; 95% confidence interval [CI], 0.53-0.74). Similarly, the risk of withdrawal due to peripheral edema was 62% lower with calcium channel blocker/renin-angiotensin system blocker combination compared with calcium channel blocker monotherapy ( P = .002) (RR 0.38; 95% CI, 0.22-0.66). ACE inhibitors were significantly more efficacious than ARBs in reducing the incidence of peripheral edema ( P < .0001) (ratio of RR 0.74; 95% CI, 0.64-0.84) (indirect comparison). Conclusion In patients with hypertension, the calcium channel blocker/renin-angiotensin system blocker combination reduces the risk of calcium channel blocker-associated peripheral edema when compared with calcium channel blocker monotherapy. ACE inhibitor seems to be more efficacious than ARB in reducing calcium channel blocker-associated peripheral edema, but head-to-head comparison studies are needed to prove this.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21295192</pmid><doi>10.1016/j.amjmed.2010.08.007</doi><tpages>8</tpages></addata></record> |
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| subjects | ACE inhibitors Aliskiren Amides - therapeutic use Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors - therapeutic use Antihypertensive Agents - administration & dosage Antihypertensive Agents - adverse effects ARBs Beta blockers Biological and medical sciences Calcium Calcium channel blockers Calcium Channel Blockers - administration & dosage Calcium Channel Blockers - adverse effects Clinical trials Drug Therapy, Combination Edema - chemically induced Edema - prevention & control Female Fumarates - therapeutic use General aspects Humans Hypertension Hypertension - drug therapy Incidence Internal Medicine Male Medical sciences Meta-analysis Middle Aged Peripheral edema Randomized Controlled Trials as Topic Renin - antagonists & inhibitors Renin-Angiotensin System - drug effects Research Design Side effects Treatment Refusal |
| title | Effect of Renin-Angiotensin System Blockade on Calcium Channel Blocker-Associated Peripheral Edema |
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