. 2024 Jan 18;25:24. doi: 10.1186/s12882-023-03450-5

Table 2.

Studies comparing the effect of RAAS inhibitors drugs versus CCBs in renal and cardiovascular outcomes in patients with kidney disease

Study	Evaluated Outcomes	Results
Fu et al (Effectiveness of RAAS inhibitors vs CCBs)	Risk of initiation of renal replacement therapy (RRT), all-cause mortality, and cardiovascular events in older patients with advanced CKD in a 10-year cohort study	• Significantly lower risk of RRT initiation following new use of ACE inhibitors compared to new use of CCBs (adjusted HR, 0.79 [95%CI, 0.69–0.89]), but similar risks of mortality (adjusted HR, 0.97 [95%CI, 0.88–1.07]) and MACE (adjusted HR, 1.00 [95%CI, 0.88–1.15]). • The positive control cohort of patients with G3 CKD showed a similar reduction in the risk of RRT initiation (adjusted HR, 0.67 [95%CI, 0.56–0.80]) with ACE inhibitor therapy compared to CCBs.
Lin et al (Systematic Review and Meta-Analysis comparing CCBs and RAAS inhibitors in patients with SAH and stage 3–5 CKD)	Changes in blood pressure, all-cause mortality, heart failure, cerebrovascular events, and renal outcomes.	• 21 studies with 9492 patients were analyzed and no significant differences were observed in any observed outcome.
Zhao et al (Systematic Review and Meta-analysis)	8 clinical trials with 25,647 patients were analyzed, examining the effect of CCBs on the incidence of CKD and all-cause mortality compared to ACE inhibitors and ARBs	• Decrease in blood pressure was similar for all pharmacological groups, with no significant difference in all-cause mortality, but finding a better nephroprotective effect for ACE inhibitors and ARBs compared to CCBs (IRR 0.96, 95%CI, 0.89–1.03).

Study

Evaluated Outcomes

Results

Fu et al

(Effectiveness of RAAS inhibitors vs CCBs)

Risk of initiation of renal replacement therapy (RRT), all-cause mortality, and cardiovascular events in older patients with advanced CKD in a 10-year cohort study

• Significantly lower risk of RRT initiation following new use of ACE inhibitors compared to new use of CCBs (adjusted HR, 0.79 [95%CI, 0.69–0.89]), but similar risks of mortality (adjusted HR, 0.97 [95%CI, 0.88–1.07]) and MACE (adjusted HR, 1.00 [95%CI, 0.88–1.15]).

• The positive control cohort of patients with G3 CKD showed a similar reduction in the risk of RRT initiation (adjusted HR, 0.67 [95%CI, 0.56–0.80]) with ACE inhibitor therapy compared to CCBs.

Lin et al

(Systematic Review and Meta-Analysis comparing CCBs and RAAS inhibitors in patients with SAH and stage 3–5 CKD)

Changes in blood pressure, all-cause mortality, heart failure, cerebrovascular events, and renal outcomes.

• 21 studies with 9492 patients were analyzed and no significant differences were observed in any observed outcome.

Zhao et al

(Systematic Review and Meta-analysis)

8 clinical trials with 25,647 patients were analyzed, examining the effect of CCBs on the incidence of CKD and all-cause mortality compared to ACE inhibitors and ARBs

• Decrease in blood pressure was similar for all pharmacological groups, with no significant difference in all-cause mortality, but finding a better nephroprotective effect for ACE inhibitors and ARBs compared to CCBs (IRR 0.96, 95%CI, 0.89–1.03).

Abbreviations: RAAS Renin-Angiotensin Aldosterone System, CCB Calcium Channel Blockers, CKD Chronic Kidney Disease, SAH Systemic Arteria Hypertension, MACE Major Cardiovascular Events, ACE Angiotensin Converting Enzyme, IRR Incidence Rate Ratio, HR Hazard Ratio