title: Effects of manidipine vs. amlodipine on intrarenal haemodynamics in patients with arterial hypertension.
abstract: OBJECTIVE
  Intraglomerular pressure is one of the main drivers of progression of renal failure. Experimental data suggest that there are important differences between calcium channel blockers (CCBs) in their renal haemodynamic effects: manidipine reduces, whereas amlodipine increases intraglomerular pressure. The aim of this study was to investigate the effects of manidipine and amlodipine treatment on intragomerular pressure (P(glom)) in patients with mild to moderate essential hypertension.
  
  
  METHODS
  In this randomized, double-blind, parallel group study, hypertensive patients were randomly assigned to receive manidipine 20 mg (n = 54) or amlodipine 10 mg (n = 50) for 4 weeks. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were determined by constant-infusion input-clearance technique with p-aminohippurate (PAH) and inulin. P(glom) and resistances of the afferent (R(A)) and efferent (R(E)) arterioles were calculated according to the model established by Gomez.
  
  
  RESULTS
  P(glom) did not change in the manidipine group (P = 0.951), whereas a significant increase occurred in the amlodipine group (P = 0.009). There was a significant difference in the change of P(glom) by 1.2 mmHg between the manidipine and amlodipine group (P = 0.042). In both treatment arms, R(A) was reduced (manidipine P = 0.018; amlodipine P < 0.001). The reduction of R(A) was significantly more pronounced with amlodipine compared with manidipine treatment (P < 0.001). R(E) increased in both treatment arms (manidipine P = 0.012; amlodipine P = 0.002), with no difference between the treatment arms. Both CCBs significantly reduced systolic and diastolic blood pressure (BP) (both P < 0.001). However, amlodipine treatment resulted in a significantly greater decrease of BP compared with manidipine (P < 0.001).
  
  
  CONCLUSIONS
  In accordance with experimental data after antihypertensive treatment of 4 weeks, intraglomerular pressure was significantly lower with the CCB manidipine than with amlodipine, resulting and explaining their disparate effects on albuminuria.
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schneider
authors.forename: Ulrike
authors.initials: U
authors.lastname: Raff
authors.forename: Martin
authors.initials: M
authors.lastname: Ritt
authors.forename: Kristina
authors.initials: K
authors.lastname: Striepe
authors.forename: Marco
authors.initials: M
authors.lastname: Alberici
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000652:urine; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000652:urine; D004095:Dihydropyridines / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009578:Nitrobenzenes; D010879:Piperazines
chemical_list: D004095:Dihydropyridines; D009578:Nitrobenzenes; D010879:Piperazines; D017311:Amlodipine; C054218:manidipine; D003404:Creatinine