Antihypertension Medication (Calcium-Channel Blockers and Angiotensin Converting Enzyme Inhibitors) on Blood Pressure Among Older People with Hypertension: A Meta-Analysis Study
DOI:
https://doi.org/10.31154/isc12.v12i1.84.64-75Keywords:
Angiotensin Converting Enzyme Inhibitors, Blood Pressure, Calcium-Channel Blockers, HypertensionAbstract
Abstract - Many medications are used to treat high blood pressure. Calcium Channel Blockers (CCB) and Angiotensin Converting Enzyme Inhibitors (ACEI) are the most commonly prescribed for patients with hypertension. Both have proven to be effective in lowering blood pressure, but they can vary from one person to another, depending on patient characteristics. This study aims to investigate the effect of antihypertension medication CCB and ACEI on systolic blood pressure among older people with hypertension. Three databases were used in a comprehensive search conducted from February to March 2025 to find relevant research published in English from 2000 to 2025. The standard mean difference with a 95% confidence interval was used to determine the effect of antihypertension medication. Three randomized controlled trial studies with 6113 respondents over 50 years old with hypertension, which were divided into 3036 participants using CCB and 3077 using ACEI. The result showed that in older people with hypertension, CCB may provide a slightly greater reduction in systolic blood pressure compared to ACEI, but the difference is not statistically significant. The use of both drugs can be recommended for older people who have hypertension, independent of their comorbid conditions
References
Ahmad, H., Khan, H., Haque, S., Ahmad, S., Srivastava, N., & Khan, A. (2023). Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension. Journal of the Renin-Angiotensin-Aldosterone System, 2023. https://doi.org/10.1155/2023/7890188
Alghatrif, M., Tanaka, T., Moore, A. Z., Bandinelli, S., Lakatta, E. G., & Ferrucci, L. (2021). Age-associated difference in circulating ACE2, the gateway for SARS-COV-2, in humans: results from the InCHIANTI study. GeroScience, 43(2), 619–627. https://doi.org/10.1007/s11357-020-00314-w
Benetos, A., Petrovic, M., & Strandberg, T. (2019). Hypertension Management in Older and Frail Older Patients. Circulation Research, 124(7), 1045–1060. https://doi.org/10.1161/CIRCRESAHA.118.313236
Bhutto, F., Alhazza, S., Alkadhi, B., Alshehri, F., Alshehri, D., & Alghamdi, N. (2024). Efficacy and safety of ACE inhibitors versus calcium channel blockers in the management of hypertension in adults: a systematic review. International Journal of Medicine in Developing Countries, 2549–2559. https://doi.org/10.24911/IJMDC.51-1727118608
Blumenthal, D. K., & Stull, J. T. (1980). Activation of skeletal muscle myosin light chain kinase by calcium(2+) and calmodulin. Biochemistry, 19(24), 5608–5614. https://doi.org/10.1021/bi00565a023
Bueno, V., & Frasca, D. (2023). Mini-review: Angiotensin- converting enzyme 1 (ACE1) and the impact for diseases such as Alzheimer’s disease, sarcopenia, cancer, and COVID-19. Frontiers in Aging, 4. https://doi.org/10.3389/fragi.2023.1117502
Cushman, W. C. (2016). JS ISH-ESH-4 WHAT DO CLINICAL TRIALS TEACH US ABOUT SELECTION OF ANTIHYPERTENSIVE DRUGS. Journal of Hypertension, 34(Supplement 1), e193. https://doi.org/10.1097/01.hjh.0000500423.95537.83
Fang, X., Bogdanov, V., Davis, J. P., & Kekenes-Huskey, P. M. (2023). Molecular Insights into the MLCK Activation by CaM. Journal of Chemical Information and Modeling, 63(23), 7487–7498. https://doi.org/10.1021/acs.jcim.3c00954
Godfraind, T. (2017). Discovery and Development of Calcium Channel Blockers. Frontiers in Pharmacology, 8. https://doi.org/10.3389/fphar.2017.00286
Holzapfel, G., Wehland, J., & Weber, K. (1983). Calcium control of actin-myosin based contraction in triton models of mouse 3T3 fibroblasts is mediated by the myosin light chain kinase (MLCK)-calmodulin complex. Experimental Cell Research, 148(1), 117–126. https://doi.org/10.1016/0014-4827(83)90192-1
Huang, Q., Sheng, C., Li, Y., Dou, Y., Zheng, M., Zhu, Z., & Wang, J. (2019). A randomized controlled trial on the blood pressure–lowering effect of amlodipine and nifedipine‐GITS in sustained hypertension. The Journal of Clinical Hypertension, 21(5), 648–657. https://doi.org/10.1111/jch.13543
Iepsen, U. W., Hjortdal, A. R., Thuesen, A. D., Finsen, S. H., Hansen, P. B. L., & Mortensen, S. P. (2024). The role of T‐type calcium channels in elderly human vascular function: A pilot randomized controlled trial. Experimental Physiology, 109(5), 779–790. https://doi.org/10.1113/EP091645
Jones, K. E., Hayden, S. L., Meyer, H. R., Sandoz, J. L., Arata, W. H., Dufrene, K., Ballaera, C., Lopez Torres, Y., Griffin, P., Kaye, A. M., Shekoohi, S., & Kaye, A. D. (2024). The Evolving Role of Calcium Channel Blockers in Hypertension Management: Pharmacological and Clinical Considerations. Current Issues in Molecular Biology, 46(7), 6315–6327. https://doi.org/10.3390/cimb46070377
Lee, E. M. (2023). Calcium channel blockers for hypertension: old, but still useful. Cardiovascular Prevention and Pharmacotherapy, 5(4), 113–125. https://doi.org/10.36011/cpp.2023.5.e16
Medmovie. (2025). Calcium Chanel Blocker. Medmovie. https://medmovie.com/library_id/3255/topic/ahaw_0247i/
Nather, K., Loughrey, C. M., & Nicklin, S. A. (2019). Vasoactive Peptides: Renin-Angiotensin-Aldosterone System. In Textbook of Vascular Medicine (pp. 93–101). Springer International Publishing. https://doi.org/10.1007/978-3-030-16481-2_9
Ottolini, M., Hong, K., & Sonkusare, S. K. (2019). Calcium signals that determine vascular resistance. WIREs Systems Biology and Medicine, 11(5). https://doi.org/10.1002/wsbm.1448
Remonti, L. R., Dias, S., Leitão, C. B., Kramer, C. K., Klassman, L. P., Welton, N. J., Ades, A. E., & Gross, J. L. (2016). Classes of antihypertensive agents and mortality in hypertensive patients with type 2 diabetes—Network meta-analysis of randomized trials. Journal of Diabetes and Its Complications, 30(6), 1192–1200. https://doi.org/10.1016/j.jdiacomp.2016.04.020
Rosenberg, A. J., Schroeder, E. C., Grigoriadis, G., Wee, S. O., Bunsawat, K., Heffernan, K. S., Fernhall, B., & Baynard, T. (2020). Aging reduces cerebral blood flow regulation following an acute hypertensive stimulus. Journal of Applied Physiology, 128(5), 1186–1195. https://doi.org/10.1152/japplphysiol.00137.2019
Senbonmatzu, T., & Katoh, M. (2025). Renin-Angiotensin-Aldosterone System - Latest Trends. IntechOpen. https://doi.org/10.5772/intechopen.1003465
Singh, A., & Singh, K. (2024). Pathology of the Renin-Angiotensin-Aldosterone System. In Renin-Angiotensin-Aldosterone System - Latest Trends. IntechOpen. https://doi.org/10.5772/intechopen.1007937
Singh, J., Elton, A., & Kwa, M. (2023). Comparison of various calcium antagonist on vasospastic angina: a systematic review. Open Heart, 10(1), e002179. https://doi.org/10.1136/openhrt-2022-002179
Sinnott, S.-J., Douglas, I. J., Smeeth, L., Williamson, E., & Tomlinson, L. A. (2020). First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care. BMJ, m4080. https://doi.org/10.1136/bmj.m4080
Sobhy, M., Eletriby, A., Ragy, H., Kandil, H., Saleh, M. A., Farag, N., Guindy, R., Bendary, A., Nayel, A. M. E., Shawky, A., Khairy, A., Mortada, A., Zarif, B., Badran, H., Khorshid, H., Mahmoud, K., Said, K., Leon, K., Abdelsabour, M., … Abdelhady, Y. (2024). ACE Inhibitors and Angiotensin Receptor Blockers for the Primary and Secondary Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus in Collaboration with the CVREP Foundation. Cardiology and Therapy, 13(4), 707–736. https://doi.org/10.1007/s40119-024-00381-6
Stull, J. T., Kamm, K. E., & Vandenboom, R. (2011). Myosin light chain kinase and the role of myosin light chain phosphorylation in skeletal muscle. Archives of Biochemistry and Biophysics, 510(2), 120–128. https://doi.org/10.1016/j.abb.2011.01.017
Sueta, D., Tabata, N., & Hokimoto, S. (2017). Clinical roles of calcium channel blockers in ischemic heart diseases. Hypertension Research, 40(5), 423–428. https://doi.org/10.1038/hr.2016.183
Topuz, İ., & Topuz, A. (2024). AGING AND CARDIOVASCULAR DISEASES. Sağlık Bilimleri Dergisi, 33(3), 406–412. https://doi.org/10.34108/eujhs.1451664
Touyz, R. M., Alves-Lopes, R., Rios, F. J., Camargo, L. L., Anagnostopoulou, A., Arner, A., & Montezano, A. C. (2018). Vascular smooth muscle contraction in hypertension. Cardiovascular Research, 114(4), 529–539. https://doi.org/10.1093/cvr/cvy023
Tülümen, E., & Borggrefe, M. (2020). Modulation of Calcium Handling: Calcium-Channel Modulators. In Antiarrhythmic Drugs (pp. 233–264). Springer International Publishing. https://doi.org/10.1007/978-3-030-34893-9_5
Van-Lier, D., Kox, M., Santos, K., van der Hoeven, H., Pillay, J., & Pickkers, P. (2021). Increased blood angiotensin converting enzyme 2 activity in critically ill COVID-19 patients. ERJ Open Research, 7(1), 00848–02020. https://doi.org/10.1183/23120541.00848-2020
Yamal, J.-M., Martinez, J., Osani, M. C., Du, X. L., Simpson, L. M., & Davis, B. R. (2023). Mortality and Morbidity Among Individuals With Hypertension Receiving a Diuretic, ACE Inhibitor, or Calcium Channel Blocker. JAMA Network Open, 6(12), e2344998. https://doi.org/10.1001/jamanetworkopen.2023.44998
Yin, J., Mei, Z., Shi, S., Du, P., & Qin, S. (2022). Nifedipine or amlodipine? The choice for hypertension during pregnancy: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 306(6), 1891–1900. https://doi.org/10.1007/s00404-022-06504-5
Zheng, W., Tian, E., Liu, Z., Zhou, C., Yang, P., Tian, K., Liao, W., Li, J., & Ren, C. (2022). Small molecule angiotensin converting enzyme inhibitors: A medicinal chemistry perspective. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.968104

