Benidipine reduces albuminuria and plasma aldosterone in mild-to-moderate stage chronic kidney disease with albuminuria.
Benidipine inhibits both L- and T-type Ca channels, and has been shown to dilate the efferent arterioles as effectively as the afferent arterioles. In this study, we conducted an open-label and randomized trial to compare the effects of benidipine with those of amlodipine on blood pressure (BP), albuminuria and aldosterone concentration in hypertensive patients with mild-to-moderate stage chronic kidney disease (CKD). Patients with BP ≥ 130/80 mm Hg, with estimated glomerular filtration rate (eGFR) of 30-90 ml min(-1) per 1.73 m(2), and with albuminuria>30 mg per g creatinine (Cr), despite treatment with the maximum recommended dose of angiotensin II receptor blockers (ARBs) were randomly assigned to two groups. Patients received either of the following two treatment regimens: 2 mg per day benidipine, which was increased up to a dose of 8 mg per day (n=52), or 2.5 mg per day amlodipine, which was increased up to a dose of 10  mg per day (n=52). After 6 months of treatment, a significant and comparable reduction in the systolic and diastolic BP was observed in both groups. The decrease in the urinary albumin to Cr ratio in the benidipine group was significantly lower than that in the amlodipine group. Although plasma renin activity was not different in the two groups, plasma aldosterone levels were significantly decreased in the benidipine group. Moreover, urinary Na/K ratio was significantly decreased in the benidipine group but remained unchanged in the serum. It may be concluded that benidipine results in a greater reduction of plasma aldosterone and albuminuria than amlodipine, and that these effects are independent of BP reduction.
Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan. mabe@med.nihon-u.ac.jp
Masanori
M
Abe
Kazuyoshi
K
Okada
Noriaki
N
Maruyama
Shiro
S
Matsumoto
Takashi
T
Maruyama
Takayuki
T
Fujita
Koichi
K
Matsumoto
Masayoshi
M
Soma
D000368:Aged; D000419:Albuminuria / Q000188:drug therapy*; D000450:Aldosterone / Q000097:blood*; D017311:Amlodipine / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002908:Chronic Disease; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy*; D004095:Dihydropyridines / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications / Q000188:drug therapy*; D011188:Potassium / Q000652:urine; D012720:Severity of Illness Index; D012964:Sodium / Q000652:urine
D057911:Angiotensin Receptor Antagonists; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D017311:Amlodipine; D000450:Aldosterone; C061004:benidipine; D012964:Sodium; D011188:Potassium