Are differences in calcium antagonists relevant across all stages of nephropathy or only proteinuric nephropathy?
OBJECTIVE
The main effects of classic calcium antagonists are mediated by the inhibition of L-type calcium channels broadly distributed within the renal vascular bed. Calcium antagonists act predominantly on the afferent arterioles, and dihydropyridines can favour the increase in glomerular hypertension and progression of kidney diseases, in particular when systemic blood pressure remains uncontrolled.


RESULTS
Calcium antagonists have been widely used in clinical practice because of their antihypertensive capacity. The prevention of renal damage is a very important aim of antihypertensive therapy. This is particularly so taking into account the high prevalence of chronic kidney disease in the general population. Non-dihydropyridines such as verapamil have been shown to possess an antiproteinuric effect that could be particularly relevant.


CONCLUSIONS
Recent data from clinical trials have confirmed that, in hypertensive patients with preserved renal function or with chronic kidney disease, calcium antagonists are effective antihypertensive drugs to be considered alone or in combination with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In those patients presenting with proteinuric kidney disease, non-dihydropyridines could reduce proteinuria to a greater degree than dihydropyridines.
Segura
Julián
J
Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
García-Donaire
José A
JA
Ruilope
Luis M
LM
D000419:Albuminuria / Q000188:drug therapy / Q000378:metabolism; D000809:Angiotensins / Q000737:chemistry; D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure; D002118:Calcium / Q000037:antagonists & inhibitors*; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D004095:Dihydropyridines / Q000737:chemistry; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000378:metabolism; D007674:Kidney Diseases / Q000188:drug therapy*; D011507:Proteinuria / Q000188:drug therapy*
D000809:Angiotensins; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C038806:1,4-dihydropyridine; D002118:Calcium