Efficacy and Safety of ARB-Based Combination Therapies for Treatment of Hypertension: A Systematic Review and Meta-analyses.

INTRODUCTION

Hypertension is leading non communicable disease associated with high morbidity and mortality. There is uncertainty about the superiority of angiotensin receptor blocker (ARB)-diuretic versus ARB-calcium channel blocker (CCB) combination for the treatment of hypertension.

AIM: This meta-analysis compares the effectiveness of angiotensin receptor blocker (ARB)-diuretic versus ARB-calcium channel blocker (CCB) combination therapies in adults with hypertension.

METHODS

RCTs were identified through PubMed, Embase, Scopus, and Cochrane Central; data were analyzed using RevMan 5.4.1 with a random-effects model. Primary outcomes were mortality, systolic blood pressure (SBP), and diastolic blood pressure (DBP); secondary outcomes included serum electrolytes and renal function.

RESULTS

3549 studies were identified based on database searches. 19 studies were included for analyses. Meta-analysis revealed no significant difference between both the combination therapies for primary outcomes: all-cause mortality [RR: 1.19 (95% CI: 0.85 to 1.65; p = 0.31)], SBP [MD: 1.24 mmHg (95% CI: - 0.48 to 2.96; p = 0.16; I² = 59%)], and DBP [MD: 0.62 mmHg (95% CI: - 0.15 to 1.38; p = 0.11; I² = 0%)]. The diuretic group showed significant changes in serum sodium, chloride, creatinine, e-GFR, and increased uric acid. Risk of bias was mostly low, with moderate to high evidence certainty.

CONCLUSION

Both ARB + CCB and ARB + diuretic combinations showed comparable effectiveness in lowering blood pressure and all-cause mortality in hypertensive adults. ARB + CCB seems to be having good safety profile, with better renal functions based on biomarkers.