The use of calcium antagonists in the treatment of hypertensive persons with kidney disease.
The treatment of hypertension is proven to reduce cardiovascular and renal risk. Combination drug therapy is becoming recognized as a necessity in most patients with hypertension and kidney disease. Allegations about the safe use of calcium antagonists in patients with kidney disease have led to questions and confusion about their use in this common condition. This article reviews the cardiovascular and renal safety of the long-acting calcium antagonists from studies comparing calcium antagonists with placebo and with angiotensin converting enzyme inhibitors or angiotensin receptor blockers in patients with kidney disease and hypertension. Patients with proteinuria and kidney disease should have their blood pressure brought as close to target (< 130/80 mm Hg) as possible for cardiovascular and renal protection. Lowering blood pressure in this setting will require an average of three antihypertensive agents. In patients with hypertension and proteinuria, angiotensin converting enzyme inhibitors or angiotensin receptor blockers must be part of the regimen, and calcium antagonists are safe and effective in this condition when used with them in combination.
Tobe
Sheldon
S
Division of Nephrology, Sunnybrook and Women"s College HSC, A240 2075 Bayview Avenue, Toronto, Canada M4N 3M5. sheldon.tobe@swchsc.on.ca
Epstein
Murray
M
D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007674:Kidney Diseases / Q000209:etiology / Q000378:metabolism*
D002121:Calcium Channel Blockers