Arteriosclerosis and antihypertensive response to calcium antagonists in end-stage renal failure

The relationship between the presence of arterial calcinosis and the antihypertensive response to calcium blockers was studied in 40 hypertensive patients with end-stage renal failure (ESRF) on chronic hemodialysis, before and during 16 weeks after administration of nitrendipine in monotherapy. In a double-blind, placebo-controlled, randomized study, nitrendipine reduced systolic blood pressure regardless of the presence or absence of arterial calcifications. The antihypertensive effect was significantly more pronounced in subjects with aortic calcium deposits in comparison with patients without clinical signs of arteriosclerosis (p less than 0.01). The diastolic blood pressure was significantly reduced only in patients with aortic calcifications, and remained unchanged in subjects with noncalcified aorta. The aortic pulse wave velocity decreased significantly in patients with aortic calcifications (p less than 0.001), but remained unaffected in patients with noncalcified vessels. Multivariate regression analysis showed that the antihypertensive action of nitrendipine was correlated to the presence of aortic calcium deposits independent of age or baseline blood pressure levels. The results of the present study indicate that an overt arteriosclerosis as demonstrated by the presence of aortic calcifications on abdominal radiographs is a good indication for the use of dihydropyridines in patients with ESRF.