Antihypertensive and renoprotective effects of trandolapril/verapamil combination: a meta-analysis of randomized controlled trials

J Hum Hypertens. 2011 Mar;25(3):203-10. doi: 10.1038/jhh.2010.60. Epub 2010 Jun 10.

Abstract

Both trandolapril and verapamil are effective and widely used antihypertensive agents. The aim of this study was to estimate the efficacy and tolerability of trandolapril/verapamil (Tr/Ve) combination for blood pressure control and renoprotection. PubMed, EMBASE and Cochrane Library were searched for relevant studies. A meta-analysis of all randomized controlled trials (RCTs) meeting the criteria was performed. Twelve RCTs were ultimately included out of 62 studies. (1) Combination versus trandolapril: a greater diastolic blood pressure (DBP) reduction (weighted mean difference (WMD): 3.71, 95% confidence interval (CI): 1.84-5.57); a greater reduction in albuminuria (WMD: 136.77, 95% CI: 12.44-261.09). There were no differences in reduction in systolic blood pressure (SBP), blood pressure response rate or proteinuria. (2) Combination versus verapamil: a greater SBP reduction (WMD: 6.14, 95% CI: 3.59-8.70); a greater DBP reduction (WMD: 2.49, 95% CI: 0.81-4.17); a greater reduction in proteinuria (standardized mean difference: 0.84, 95% CI: 0.22-1.45); a greater reduction in albuminuria (WMD: 255.00, 95% CI: 119.26-390.74). (3) Incidence of all-cause adverse events (AEs) was comparable between combination and monotherapy. The present meta-analysis indicates that Tr/Ve combination provides a superior blood pressure control and a favourable renoprotective effect without an increase of overall AEs than verapamil monotherapy. The combination also shows a slight advantage over trandolapril monotherapy by reducing DBP and albuminuria to a greater extent.

Publication types

  • Meta-Analysis

MeSH terms

  • Albuminuria / drug therapy
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Drug Therapy, Combination / adverse effects
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Indoles / adverse effects
  • Indoles / therapeutic use*
  • Kidney / drug effects*
  • Kidney Diseases / etiology
  • Kidney Diseases / prevention & control*
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Verapamil / adverse effects
  • Verapamil / therapeutic use*

Substances

  • Antihypertensive Agents
  • Indoles
  • trandolapril
  • Verapamil