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Effects of calcium antagonists on the hypertensive kidney
Insights
Calcium antagonists, particularly dihydropyridines, improve renal blood flow and filtration in hypertensive patients. Long-term studies are needed to confirm their benefit in treating hypertensive renal disease.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Hypertension frequently leads to renal damage.
- Calcium antagonists are widely used antihypertensive agents.
- Understanding their renal effects is crucial for patient management.
Purpose of the Study:
- To review the effects of various calcium antagonists on renal function in hypertensive humans.
- To assess both acute and chronic impacts on key renal parameters.
Main Methods:
- Systematic review of studies on diltiazem, verapamil, and dihydropyridine calcium antagonists.
- Analysis of effects on glomerular filtration rate (GFR), effective renal plasma flow (ERPF)/renal blood flow (RBF), renal vascular resistance (RVR), and proteinuria.
Main Results:
- Dihydropyridine calcium antagonists consistently increase acute ERPF/RBF; effects on GFR are variable.
- Chronic therapy with several calcium antagonists sustains increases in ERPF/RBF and/or GFR.
- Renal vascular resistance is reduced, and urinary protein excretion is often decreased.
Conclusions:
- Calcium antagonists, especially dihydropyridines, appear to preserve or improve renal perfusion and GFR in hypertensive individuals.
- Further long-term clinical trials are necessary to establish the therapeutic role of calcium antagonists in modifying hypertensive renal disease progression.
Abstract:
This review focuses on the effects of calcium antagonists on renal function in hypertensive human subjects. Specifically assessed are the acute and chronic effects of diltiazem, verapamil, amlodipine, felodipine, isradipine, nicardipine, nifedipine, and nitrendipine on glomerular filtration rate; effective renal plasma flow/renal blood flow; renal vascular resistance; and urinary protein excretion. Among the calcium antagonists, only the dihydropyridine derivatives have been demonstrated consistently to acutely increase effective renal plasma flow/renal blood flow. The acute effects on glomerular filtration rate are variable. With respect to chronic therapy, many of the calcium antagonists have been reported to produce sustained increases in the effective renal plasma flow/renal blood flow and/or the glomerular filtration rate. Renal vascular resistance is reduced. Although calcium antagonists preserve or improve renal perfusion and glomerular filtration, long-term clinical trials are required to determine their potential therapeutic benefit to modify the natural course of hypertensive renal disease.