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Update on calcium antagonists and the kidney
1Division of Nephrology, Sunnybrook and Women's College, Health Sciences Center, University of Toronto, Toronto, Canada. sheldon.tobe@swchsc.on.ca
Current Opinion in Nephrology and Hypertension
|April 17, 2003
Summary
Effective hypertension management involves identifying patients and achieving blood pressure targets. Calcium antagonists are crucial for combination therapy, especially in patients with renal disease and nephropathy, to reduce cardiovascular and renal risk.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Hypertension treatment reduces cardiovascular and renal risk.
- Past confusion regarding long-acting calcium channel antagonists stemmed from limited clinical trials.
- Recent large-scale trials have clarified their role, particularly in diabetic and renal disease populations.
Purpose of the Study:
- To review the current understanding of antihypertensive therapies, focusing on calcium channel antagonists.
- To highlight the importance of blood pressure control in patients with diabetes and renal disease.
- To assess the role of different drug classes in achieving blood pressure targets.
Main Methods:
- Analysis of major clinical trials published in the last year, including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.
- Review of studies on blood pressure control in patients with kidney disease (e.g., African American Study of Kidney Disease and Hypertension).
- Examination of publications on blood pressure control in diabetic patients (e.g., Appropriate Blood Pressure Control in Diabetes trial).
Main Results:
- Blood pressure control is achievable with first-line agents: diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors.
- Diuretics are recommended as initial therapy for hypertension due to clinical and economic benefits.
- Calcium antagonists are effective and well-tolerated, suitable for initial therapy or when multiple drugs are needed.
- Angiotensin-converting enzyme inhibitors are essential for patients with nephropathy, typically requiring combination therapy.
- Renal function is increasingly recognized as a critical outcome measure and cardiovascular risk marker.
Conclusions:
- The primary goal is identifying hypertensive individuals and achieving target blood pressure.
- Multiple drug therapy, including calcium antagonists, is often necessary for patients with hypertension and renal disease.
- Nephropathic patients require special attention due to higher progression risk and the need for combination therapy, representing a focus for future research.