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Systematic review the effects of renin-angiotensin system inhibitors plus calcium channel blockers(RC) and renin-angiotensin system inhibitors plus thiazide diuretics(RD) on antihypertensive efficacy, carbohydrate metabolism, lipid metabolism, electrolyte and renal function in patients with primary hypertension.
Such databases as PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant studies from inception to April, 2016. Two reviewers independently screened literatures, extracted data, and assessed the methodological quality of the included studies according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration. The Meta-analysis was performed using RevMan 5.3 software.
23 studies consisting of 8495 patients with primary hypert-ension were inclu-ded. The results of systematic review showed that RC group was more effective- than RD group in decreasing diastolic blood pressure(DBP)[MD=-0.73, 95%CI(-1.14, -0.32), P=0.004]. RC increased serum sodium[MD=0.30, 95%CI(0.14, 0.46), P=0.0003], estimated glomerular filtration rate(eGFR)[MD=7.39, 95% CI(5.75, 9.03), P<0.00001], red-uced triglyceride(TG)[MD=-0.17, 95%CI(-0.32, -0.02), P=0.02], serumuric acid[MD=-0.66, 95%CI(-0.87, -0.45), P<0.00001] and serum creatinine level of diabetes mellitus or abnormal kidn-ey function group[MD=-0.65, 95% CI(-0.88, -0.42), P<0.00001] compare with RD group. But no significant differences were found between the two groups in the rate of mark blood pressure[OR=0.99, 95%CI(0.89, 1.09), P=0.78], the c-hange of systolic blood pressure(SBP)[MD=-0.25,95%CI(-0.82, 0.32), P=0.39], total cholesterol(TC)[MD=-0.04, 95%CI(-0.20, 0.12), P=0.65], high density lipo-proteincholesterol(HDL-C)[MD=0.24, 95%CI(-0.02, 0.50), P=0.07], low dens-ity lipoproteincholesterol(LDL-C)[MD=-0.14, 95% CI(-0.44, 0.15), P=0.34], haemoglobinA1c(HbA1c) [MD=-0.09, 95%CI(-0.21, 0.04), P=0.19], fasting plasma glucose(FPG)[MD=-0.05, 95% CI(-0.18, 0.09), P=0.52], serum potas-sium[MD=0.02, 95% CI(-0.04, 0.08), P=0.43]and serum creatinine level of hy-pertension without obvious abnormal kidney function or diabetes mellitus group[MD=-0.02, 95% CI(-0.26, 0.21), P=0.85].
RC was slightly better than RD in reducing DBP. RD treatment easily induced high blood triglycerides, high uric acid hematic disease, hyponatremia in primary hy-pertension and increase the serum creatinine level of primary hypertension with abno-rmal renal function compared with RC. With some limitations of the study, we still need further large randomized controlled clinical study to argument.