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Renal effects of diltiazem in primary hypertension
Insights
Diltiazem effectively lowers blood pressure in hypertensive patients. It improved kidney function in those with pre-existing renal impairment, without affecting overall fluid balance.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Background:
- Diltiazem is a calcium channel blocker used for hypertension.
- Its effects on renal function and fluid balance in primary hypertension are not fully understood.
Purpose of the Study:
- To investigate the effects of diltiazem monotherapy on renal function, salt and water excretion, and body fluid composition in patients with primary hypertension.
Main Methods:
- Prospective study of 18 primary hypertension patients.
- Comparison between placebo and 8 weeks of diltiazem monotherapy.
- Assessment of mean arterial pressure, glomerular filtration rate, renal plasma blood flow, salt/water excretion, and body fluid composition.
Main Results:
- Diltiazem effectively reduced mean arterial pressure.
- No significant changes in overall glomerular filtration rate, renal plasma blood flow, salt/water excretion, or body fluid composition were observed.
- Renal vascular resistance decreased.
- In patients with baseline glomerular filtration rates ≤ 80 ml/min/1.73 m2, diltiazem significantly improved glomerular filtration rate and effective renal plasma flow.
Conclusions:
- Diltiazem is an effective antihypertensive agent with no adverse effects on overall renal function or fluid balance in primary hypertension.
- Diltiazem demonstrates renoprotective effects in hypertensive patients with impaired renal function, potentially by attenuating intrarenal neurohormonal activity.
Abstract:
Although the calcium channel blocker diltiazem has been shown to be an effective antihypertensive agent, its effect on renal function, salt and water excretion, and body fluid composition has not been well characterized in patients with primary hypertension. Therefore, these parameters were prospectively studied in 18 subjects with primary hypertension after placebo and 8 weeks of diltiazem monotherapy. Diltiazem monotherapy was confirmed to be an effective antihypertensive agent. Although mean arterial pressure was reduced from 121 to 108 mm Hg, diltiazem had no overall effect on glomerular filtration rate, renal plasma blood flow, salt and water excretion, or body fluid composition. Renal vascular resistance, however, was decreased. In subjects with pretreatment glomerular filtration rates of 80 ml/min/1.73 m2 or less, diltiazem therapy was associated with marked improvement in glomerular filtration rate (48%) and effective renal plasma flow (36%). Since the filtration fraction was unchanged, changes in glomerular filtration rate may have been related to the attenuated intrarenal effects of angiotensin II or norepinephrine, or both.