Abstract 12912: Efficacy of Calcium Channel Blockers in Comparison to Renin-Angiotensin System Inhibitors on Urinary Albumin Excretion in Hypertensive Patient With Diabetic Nephropathy. A Meta-Analysis of Randomized Control Trials

IntroductionInhibitors of the renin-angiotensin system (RAS) are a cornerstone of the management of hypertension in patients with diabetic nephropathy (DN). Calcium channel blockers (CCB ) have been proposed as an alternative therapy in these patients but the current level of evidence is limited and contradictory.HypothesisCCB reduce albuminuria to similar a extent as RAS inhibitors.MethodsWe searched MEDLINE, EMBASE and CENTRAL without language, date or geographic restrictions for randomized controlled trial (RCTs) that compared CCB to RAS inhibitors in hypertensive patients with DN and assessed urinary albumin excretion. The data were pooled as standardized mean difference (SMD) in a random-effects meta-analysis. Abstract screening and data extraction were performed according to PRISMA guidelines by 2 independent reviewers.ResultsWe included 23 RCTs (n=1805). Most studies measured urinary albumin excretion in a 24-h collection, though few studies measured it in an overnight urinary collection. The urinary albumin-creatinine ratio was measured in a random urinary sample in 4 studies. Overall, RAS inhibitors improved albuminuria to a greater extent than CCB ( SMD -0.442; CI -0.660 to -0.225; p < 0.001).ConclusionsThis study provides high quality evidence confirming that therapy with RAS inhibitors is superior to therapy with CCB for albuminuria in patients with hypertension and DN.