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Long-term effects of calcium antagonists on augmentation index in hypertensive patients with chronic kidney disease:

Tsuneo Takenaka1, Takeru Seto, Mika Okayama

  • 1Department of Nephrology, Saitama Medical University, Faculty of Medicine, Moroyama, Japan. takenaka @ saitama-med.ac.jp

American Journal of Nephrology
|April 21, 2012
PubMed

Insights

Azelnidipine (AZ) combined with an angiotensin receptor blocker (ARB) is superior to amlodipine (AM) for reducing proteinuria and improving arterial stiffness in chronic kidney disease (CKD) patients. This combination therapy offers significant benefits for renal function and cardiovascular health.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Previous research indicated benidipine's superiority over amlodipine (AM) in reducing proteinuria and preserving augmentation index (AI) in chronic kidney disease (CKD) patients.
  • Hypertension management in CKD requires careful consideration of antihypertensive agents due to potential impacts on renal function and cardiovascular parameters.

Purpose of the Study:

  • To compare the long-term effects of azelnidipine (AZ) versus amlodipine (AM) on proteinuria, renal function, and arterial stiffness in hypertensive CKD patients inadequately controlled by an ARB and another calcium channel blocker.

Main Methods:

  • A randomized study enrolled CKD patients on ARB and a non-AM/AZ calcium channel blocker.
  • Patients received either AM (5 mg) or AZ (16 mg) for one year.
  • Clinical parameters including proteinuria, serum creatinine, and AI were measured at baseline and after one year.

Main Results:

  • Both AM and AZ similarly reduced brachial and central blood pressures.
  • AZ significantly decreased pulse rate, while AM increased it (p < 0.0001).
  • Greater proteinuria reduction (-38% vs. -29%, p < 0.01) and improved AI (-9% vs. -4%, p < 0.05) were observed with AZ compared to AM. Estimated GFR remained stable in both groups.

Conclusions:

  • Combined treatment with azelnidipine (AZ) and an ARB effectively reduces proteinuria in hypertensive CKD patients.
  • AZ preferentially improves arterial reflection and stiffness compared to AM in this patient population.
  • AZ represents a potentially advantageous therapeutic option for managing hypertension and proteinuria in CKD.
Abstract

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