Meta-analysis of nifedipine and enalapril combination therapy for hypertensive patients with coronary heart disease: A systematic review and meta-analysis

TL;DR

Combining nifedipine and enalapril is more effective than nifedipine alone for treating hypertension with coronary heart disease, according to a meta-analysis.

Contribution

This study provides updated evidence on the combined use of nifedipine and enalapril for hypertension and coronary heart disease through a systematic review and meta-analysis.

Findings

The combination therapy showed a significantly higher overall effectiveness rate (OR=3.47) compared to nifedipine alone.

The combination therapy resulted in greater blood pressure reduction and improved cardiac function (OR=5.55).

The control group had fewer ischemic events compared to the trial group (OR=0.35).

Abstract

Numerous clinical studies have demonstrated that the therapeutic efficacy of combining nifedipine and enalapril in treating hypertension with coronary heart disease surpasses that of nifedipine as a stand-alone treatment. However, the current evidence is not yet sufficient due to limitations in the sample size, and further validation is needed. To analyze and assess the clinical impact of nifedipine combined with enalapril on hypertension complicated with coronary heart disease, and provide evidence for rational drug use in clinic.

We employed a revised version of the Jadad scale to assess the quality of the research literature following a rigorous screening process. The statistical analysis was performed utilizing the software RevMan 5.4.1 for data analysis. Heterogeneity in the studies was evaluated based on the results of the Q test (P value), and the OR value of the combined effect was calculated using either the model with fixed effects or the one with random effects, with the results presented in a forest plot. Furthermore, a sensitivity analysis was conducted by excluding articles with the highest impact, and potential bias in publication was assessed through the utilization of a funnel plot.

A total of 183 articles were initially identified, and after a comprehensive review, 14 clinical randomized controlled trials were chosen for analysis. The meta-analysis findings revealed that the trial group displayed a significantly higher overall effectiveness rate compared to the control group (OR=3.47, 95%CI 2.40-5.03). Additionally, the trial group exhibited a more pronounced reduction in blood pressure and greater enhancement in cardiac function (OR=5.55, 95%CI). Conversely, the control group had a lower occurrence of ischemic events compared to the trial group (OR=0.35, 95%CI 0.24-0.50). Sensitivity analysis confirmed the stability and reliability of the combined effect size results (OR=3.91, 95%CI 2.51-6.09, P<0.00001). However, based on an assessment using funnel plot results suggested potential bias in publication.

The combined administration of nifedipine and enalapril exhibits enhanced effectiveness compared to the sole use of nifedipine in individuals diagnosed with hypertension and coronary heart disease, rendering it a valuable alternative for clinical application.

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