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Are there differences in the renal effects of calcium antagonists?
1Centro Auxologico Italiano, Milan.
Insights
Calcium antagonists affect kidney function differently. The dihydropyridine lacidipine lowers blood pressure without impairing renal function or causing fluid retention in hypertensive patients.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Calcium antagonists are widely used for hypertension.
- Their effects on renal function require further clarification.
- Newer dihydropyridine derivatives like lacidipine offer potential therapeutic advantages.
Purpose of the Study:
- To review the impact of calcium antagonists on glomerular filtration rate (GFR) and renal plasma flow (RPF).
- To specifically evaluate the effects of lacidipine on renal parameters and sodium/water balance.
- To assess the long-term renal safety profile of calcium antagonists.
Main Methods:
- Systematic review of published scientific literature.
- Analysis of studies examining renal hemodynamics and fluid balance.
- Comparison of different calcium antagonist classes and lacidipine.
Main Results:
- Calcium antagonists exhibit variable effects on GFR and RPF across studies.
- Lacidipine transiently increased RPF without altering GFR.
- Dihydropyridines showed short-term diuretic/natriuretic effects, unlike verapamil; lacidipine did not cause sodium/water retention.
Conclusions:
- Variability in renal response to calcium antagonists may relate to arteriolar tone.
- Calcium antagonists do not induce sodium and water retention during chronic use.
- Lacidipine effectively lowers blood pressure while preserving renal function and avoiding fluid retention.
Aim:
To review the effects of calcium antagonists, and of the new dihydropyridine lacidipine in particular, on the glomerular filtration rate, renal plasma flow, and the sodium to water ratio in hypertensive patients.
Methods:
Review of published data.
Results:
Different studies have shown a wide range of responses to all three subgroups of calcium antagonists in glomerular filtration rates and in renal plasma flows. In some studies there was a reduction and in others a rise in these two renal parameters. The administration of lacidipine was associated with a significant rise in renal plasma flow which disappeared with chronic treatment and no change in the glomerular filtration rate. There are only a few studies on the long-term natriuretic and diuretic effects of calcium antagonists. In the short term, dihydropyridine calcium antagonists appear to produce diuretic and natriuretic effects, but these effects are not seen with verapamil. Lacidipine showed no trend towards sodium and water retention.
Conclusions:
Reported differences between calcium antagonists in glomerular filtration and renal plasma flow probably reflect differences in the baseline tone of pre- and postglomerular arterioles. Calcium antagonists do not cause sodium and water retention during chronic therapy. The new dihydropyridine derivative lacidipine lowers blood pressure without reducing renal function or causing sodium and water retention.