Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SHAO Zhimin ^1,2 , CHEN Yan ^1,2 , ZHANG Wanjun ^1,2 ,  YAO Yingshui ^1,2

1. Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, 241002, P.R.China;
2. Institute of Chronic Disease Prevention and Control, Wannan Medical College, Wuhu, 241002, P.R.China;

Corresponding?author：

YAO Yingshui, Email: yingshuiyao@163.com

Keywords：

Nifedipine; Atorvastatin; Hypertension; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201902076

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the influence of nifedipine combined with atorvastatin on hypertension in patients with hypertension.Method PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of nifedipine combined with atorvastatin on hypertension in patients with hypertension from inception to November 20^th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.Results A total of 17 RCTs involving 1 838 patients were included. The results of meta-analysis indicated that nifedipine combined with atorvastatin was superior to nifedipine alone on SBP (MD=?8.937, 95%CI?11.913 to ?5.962, P<0.001), DBP (MD=?3.702, 95%CI?6.626 to ?0.778, P=0.013) and total effective rate (RR=1.24, 95%CI 1.07 to 1.44, P=0.003). There was no significant difference between two groups in the incidence of adverse reactions (P>0.05).Conclusions Current evidence shows that nifedipine combined with atorvastatin can significantly improve total effective rate, decrease the level of SBP and DBP, and increasing of dose not increase the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： SHAO Zhimin, CHEN Yan, ZHANG Wanjun, YAO Yingshui. Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 932-938. doi: 10.7507/1672-2531.201902076 Copy

1.	馬麗媛, 吳亞哲, 王文, 等. 《中國心血管病報告2017》要點解讀. 中國心血管雜志, 2018, 23(1): 3-6.
2.	Watanabe Y, Inaba T, Shimano H, et al. Effect of macrophage colony stimulating factor on the, advanced atherosclerosis in watanabe heritable hyperlipidemic rabbits. Horm Metab Res, 1997, 29(10): 507-509.
3.	Jurukovska-Nospal M, Arsova V, Levchanska J, et al. Effects of statins (atorvastatin) on serum lipoprotein levels in patients with primary hyperlipidemia and coronary heart disease. Prilozi, 2007, 28(2): 137-148.
4.	劉力生. 中國高血壓防治指南2010. 中國醫學前沿雜志(電子版), 2011, 3(5): 42-93.
5.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
6.	云嶷, 彭新, 原芳, 等. 硝苯地平控釋片聯合阿托伐他汀鈣治療高血壓合并冠心病的效果分析. 河南醫學研究, 2018, 27(8): 1430-1431.
7.	姜一杰. 硝苯地平控釋片聯合阿托伐他汀鈣治療高血壓合并冠心病的療效觀察. 養生保健指南, 2018, (22): 354.
8.	楊誠. 阿托伐他汀鈣聯合硝苯地平緩釋片治療高血壓合并冠心病的臨床療效觀察. 現代診斷與治療, 2015, 26(5): 1041-1042.
9.	吳照科, 李惠勉, 李凌, 等. 硝苯地平控釋片與阿托伐他汀對高血壓患者頸動脈內膜中層厚度及血管內皮功能的影響. 中國循證心血管醫學雜志, 2009, 1(4): 284-288.
10.	薛紅, 張曄, 王旭開, 等. 阿托伐他汀與硝苯地平控釋片的協同降壓作用及對血管內皮功能的影響. 第三軍醫大學學報, 2006, 28(15): 1616-1618.
11.	劉左玲, 劉衍宇, 凌云, 等. 阿托伐他汀鈣聯合硝苯地平緩釋片治療輕中度高血壓合并心臟病的療效與肝腎功能影響. 中國醫藥科學, 2015, 5(11): 66-68.
12.	黃雪茹, 王家驥. 阿托伐他汀鈣聯合硝苯地平緩釋片治療老年輕中度高血壓合并左心室肥厚的臨床療效及其對肝腎功能的影響. 實用心腦肺血管病雜志, 2015, 23(10): 61-63.
13.	黃桂琴. 硝苯地平控釋片與阿托伐他汀對高血壓患者頸動脈內膜中層厚度及血管內皮功能的影響. 內科, 2012, 7(5): 471-473.
14.	張克軍, 陶濤. 阿托伐他汀鈣聯合硝苯地平治療老年高血壓合并心律失常的療效及副作用. 臨床醫學研究與實踐, 2018, 3(23): 41-44.
15.	向紅菊, 潘港, 王福軍, 等. 阿托伐他汀對血脂正常的老年收縮期高血壓患者脈壓的影響. 心血管康復醫學雜志, 2007, 16(2): 160-162.
16.	蘇華科, 吳瑩, 甄懷蒙, 等. 阿托伐他汀聯合硝苯地平控釋片治療老年高血壓的療效觀察. 臨床和實驗醫學雜志, 2012, 11(24): 1967-1968.
17.	張戰國. 阿托伐他汀聯合硝苯地平治療老年單純收縮期高血壓療效分析. 中國現代藥物應用, 2009, 3(6): 127-128.
18.	李衛紅, 羅晉. 硝苯地平控釋片聯合阿托伐他汀治療原發性高血壓102例臨床研究. 實用臨床醫學, 2010, 11(4): 11-13.
19.	楊文仙. 阿托伐他汀鈣聯合硝苯地平治療原發性高血壓效果觀察. 中國鄉村醫藥, 2017, 24(2): 39-40.
20.	葛夢丹. 硝苯地平聯合阿托伐他汀治療老年高血壓伴動脈硬化的臨床觀察與分析. 海峽藥學, 2013, 25(3): 68-70.
21.	陳偉, 張亞西. 硝苯地平控釋片聯合阿托伐他汀治療高血壓合并冠心病及對超敏C反應蛋白及血管內皮功能的影響. 檢驗醫學與臨床, 2015, 12(1): 40-42.
22.	景占聰. 硝苯地平聯合不同藥物治療老年高血壓療效分析. 中國保健營養(上旬刊), 2013, 23(8): 4556-4556.
23.	Stevens W, Peneva D, Li JZ, et al. Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China. BMC Health Serv Res, 2016, 16: 175.
24.	史瓊, 鄭東鵬. 血脂異常危險因素的研究進展. 上海醫藥, 2018, 39(20): 43-46.
25.	周鳳英. 高血壓和高血脂的相關性分析. 臨床醫藥實踐, 2010, 19(4): 154-156.
26.	Sever PS, Dahl?f B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Drugs, 2004, 64(Suppl 2): 43-60.
27.	趙麗麗, 羅勇. 阿托伐他汀在高血壓病治療中的研究進展. 中華臨床醫師雜志(電子版), 2011, 5(9): 2672-2674.
28.	Wilkinson IB, Prasad K, Hall IR, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol, 2002, 39(6): 1005-1011.
29.	Danao?lu Z, Kültürsay H, Kayik?io?lu M, et al. Effect of statin therapy added to ACE-inhibitors on blood pressure control and endothelial functions in normolipidemic hypertensive patients. Anadolu Kardiyol Derg, 2003, 3(4): 331-337.
30.	Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol, 2002, 39(6): 1020-1025.
31.	Wassmann S, Laufs U, Baumer A T, et al. HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species. Hypertension, 2001, 37(6): 1450-1457.
32.	盛臻強, 盧輝和, 黎葉飛, 等. 早期強化阿托伐他汀治療對不穩定性心絞痛患者NO、ET-1水平的影響. 南通大學學報(醫學版), 2012, 32(6): 474-476.
33.	Widyantoro B, Emoto N, Nakayama K, et al. Endothelial cell-derived endothelin-1 promotes cardiac fibrosis in diabetic hearts through stimulation of endothelial-to-mesenchymal transition. Circulation, 2010, 121(22): 2407-2418.
34.	Laufs U, Gertz K, Dirnagl U, et al. Rosuvastatin, a new HMG-CoA reductase inhibitor, upregulates endothelial nitric oxide synthase and protects from ischemic stroke in mice. Brain Res, 2002, 942(1-2): 23-30.
35.	Chae CU, Lee RT, Rifai N, et al. Blood pressure and inflammation in apparently healthy men. Hypertension, 2001, 38(3): 399-403.
36.	Ziegelh?ffer A, Mujko?ová J, Ferko M, et al. Dual influence of spontaneous hypertension on membrane properties and ATP production in heart and kidney mitochondria in rat: effect of captopril and nifedipine, adaptation and dysadaptation. Can J Physiol Pharmacol, 2012, 90(9): 1311-1323.
37.	ENCORE Investigators. Effect of nifedipine and cerivastatin on coronary endothelial function in patients with coronary artery disease: the ENCORE I Study (evaluation of nifedipine and cerivastatin on recovery of coronary endothelial function). Circulation, 2003, 107(3): 422-428.
38.	Azushima K, Uneda K, Tamura K, et al. Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease. Biomed Res Int, 2014, 2014: 437087.
39.	Chapman RH, Yeaw J, Roberts CS. Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees. BMC Cardiovasc Disord, 2010, 10: 29.
40.	Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension. Int J Cardiol, 2011, 146(3): 319-325.
41.	Delgado-Montero A, Zamorano JL. Atorvastatin calcium plus amlodipine for the treatment of hypertension. Expert Opin Pharmacother, 2012, 13(18): 2673-2685.

1. 馬麗媛, 吳亞哲, 王文, 等. 《中國心血管病報告2017》要點解讀. 中國心血管雜志, 2018, 23(1): 3-6.
2. Watanabe Y, Inaba T, Shimano H, et al. Effect of macrophage colony stimulating factor on the, advanced atherosclerosis in watanabe heritable hyperlipidemic rabbits. Horm Metab Res, 1997, 29(10): 507-509.
3. Jurukovska-Nospal M, Arsova V, Levchanska J, et al. Effects of statins (atorvastatin) on serum lipoprotein levels in patients with primary hyperlipidemia and coronary heart disease. Prilozi, 2007, 28(2): 137-148.
4. 劉力生. 中國高血壓防治指南2010. 中國醫學前沿雜志(電子版), 2011, 3(5): 42-93.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
6. 云嶷, 彭新, 原芳, 等. 硝苯地平控釋片聯合阿托伐他汀鈣治療高血壓合并冠心病的效果分析. 河南醫學研究, 2018, 27(8): 1430-1431.
7. 姜一杰. 硝苯地平控釋片聯合阿托伐他汀鈣治療高血壓合并冠心病的療效觀察. 養生保健指南, 2018, (22): 354.
8. 楊誠. 阿托伐他汀鈣聯合硝苯地平緩釋片治療高血壓合并冠心病的臨床療效觀察. 現代診斷與治療, 2015, 26(5): 1041-1042.
9. 吳照科, 李惠勉, 李凌, 等. 硝苯地平控釋片與阿托伐他汀對高血壓患者頸動脈內膜中層厚度及血管內皮功能的影響. 中國循證心血管醫學雜志, 2009, 1(4): 284-288.
10. 薛紅, 張曄, 王旭開, 等. 阿托伐他汀與硝苯地平控釋片的協同降壓作用及對血管內皮功能的影響. 第三軍醫大學學報, 2006, 28(15): 1616-1618.
11. 劉左玲, 劉衍宇, 凌云, 等. 阿托伐他汀鈣聯合硝苯地平緩釋片治療輕中度高血壓合并心臟病的療效與肝腎功能影響. 中國醫藥科學, 2015, 5(11): 66-68.
12. 黃雪茹, 王家驥. 阿托伐他汀鈣聯合硝苯地平緩釋片治療老年輕中度高血壓合并左心室肥厚的臨床療效及其對肝腎功能的影響. 實用心腦肺血管病雜志, 2015, 23(10): 61-63.
13. 黃桂琴. 硝苯地平控釋片與阿托伐他汀對高血壓患者頸動脈內膜中層厚度及血管內皮功能的影響. 內科, 2012, 7(5): 471-473.
14. 張克軍, 陶濤. 阿托伐他汀鈣聯合硝苯地平治療老年高血壓合并心律失常的療效及副作用. 臨床醫學研究與實踐, 2018, 3(23): 41-44.
15. 向紅菊, 潘港, 王福軍, 等. 阿托伐他汀對血脂正常的老年收縮期高血壓患者脈壓的影響. 心血管康復醫學雜志, 2007, 16(2): 160-162.
16. 蘇華科, 吳瑩, 甄懷蒙, 等. 阿托伐他汀聯合硝苯地平控釋片治療老年高血壓的療效觀察. 臨床和實驗醫學雜志, 2012, 11(24): 1967-1968.
17. 張戰國. 阿托伐他汀聯合硝苯地平治療老年單純收縮期高血壓療效分析. 中國現代藥物應用, 2009, 3(6): 127-128.
18. 李衛紅, 羅晉. 硝苯地平控釋片聯合阿托伐他汀治療原發性高血壓102例臨床研究. 實用臨床醫學, 2010, 11(4): 11-13.
19. 楊文仙. 阿托伐他汀鈣聯合硝苯地平治療原發性高血壓效果觀察. 中國鄉村醫藥, 2017, 24(2): 39-40.
20. 葛夢丹. 硝苯地平聯合阿托伐他汀治療老年高血壓伴動脈硬化的臨床觀察與分析. 海峽藥學, 2013, 25(3): 68-70.
21. 陳偉, 張亞西. 硝苯地平控釋片聯合阿托伐他汀治療高血壓合并冠心病及對超敏C反應蛋白及血管內皮功能的影響. 檢驗醫學與臨床, 2015, 12(1): 40-42.
22. 景占聰. 硝苯地平聯合不同藥物治療老年高血壓療效分析. 中國保健營養(上旬刊), 2013, 23(8): 4556-4556.
23. Stevens W, Peneva D, Li JZ, et al. Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China. BMC Health Serv Res, 2016, 16: 175.
24. 史瓊, 鄭東鵬. 血脂異常危險因素的研究進展. 上海醫藥, 2018, 39(20): 43-46.
25. 周鳳英. 高血壓和高血脂的相關性分析. 臨床醫藥實踐, 2010, 19(4): 154-156.
26. Sever PS, Dahl?f B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Drugs, 2004, 64(Suppl 2): 43-60.
27. 趙麗麗, 羅勇. 阿托伐他汀在高血壓病治療中的研究進展. 中華臨床醫師雜志(電子版), 2011, 5(9): 2672-2674.
28. Wilkinson IB, Prasad K, Hall IR, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol, 2002, 39(6): 1005-1011.
29. Danao?lu Z, Kültürsay H, Kayik?io?lu M, et al. Effect of statin therapy added to ACE-inhibitors on blood pressure control and endothelial functions in normolipidemic hypertensive patients. Anadolu Kardiyol Derg, 2003, 3(4): 331-337.
30. Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol, 2002, 39(6): 1020-1025.
31. Wassmann S, Laufs U, Baumer A T, et al. HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species. Hypertension, 2001, 37(6): 1450-1457.
32. 盛臻強, 盧輝和, 黎葉飛, 等. 早期強化阿托伐他汀治療對不穩定性心絞痛患者NO、ET-1水平的影響. 南通大學學報(醫學版), 2012, 32(6): 474-476.
33. Widyantoro B, Emoto N, Nakayama K, et al. Endothelial cell-derived endothelin-1 promotes cardiac fibrosis in diabetic hearts through stimulation of endothelial-to-mesenchymal transition. Circulation, 2010, 121(22): 2407-2418.
34. Laufs U, Gertz K, Dirnagl U, et al. Rosuvastatin, a new HMG-CoA reductase inhibitor, upregulates endothelial nitric oxide synthase and protects from ischemic stroke in mice. Brain Res, 2002, 942(1-2): 23-30.
35. Chae CU, Lee RT, Rifai N, et al. Blood pressure and inflammation in apparently healthy men. Hypertension, 2001, 38(3): 399-403.
36. Ziegelh?ffer A, Mujko?ová J, Ferko M, et al. Dual influence of spontaneous hypertension on membrane properties and ATP production in heart and kidney mitochondria in rat: effect of captopril and nifedipine, adaptation and dysadaptation. Can J Physiol Pharmacol, 2012, 90(9): 1311-1323.
37. ENCORE Investigators. Effect of nifedipine and cerivastatin on coronary endothelial function in patients with coronary artery disease: the ENCORE I Study (evaluation of nifedipine and cerivastatin on recovery of coronary endothelial function). Circulation, 2003, 107(3): 422-428.
38. Azushima K, Uneda K, Tamura K, et al. Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease. Biomed Res Int, 2014, 2014: 437087.
39. Chapman RH, Yeaw J, Roberts CS. Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees. BMC Cardiovasc Disord, 2010, 10: 29.
40. Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of atorvastatin combined with amlodipine in patients with mild-to-moderate hypertension. Int J Cardiol, 2011, 146(3): 319-325.
41. Delgado-Montero A, Zamorano JL. Atorvastatin calcium plus amlodipine for the treatment of hypertension. Expert Opin Pharmacother, 2012, 13(18): 2673-2685.

Chinese Journal of Evidence-Based Medicine

Nifedipine combined with atorvastatin in the treatment of patients with hypertension: a meta-analysis

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