Renal protection with calcium antagonists: the role of lercanidipine

Abstract

Background:

Clinical research in the field of hypertension is now increasingly focusing on the potential effects of antihypertensive treatments that may go beyond the reduction of blood pressure (BP). In particular, renal protection appears as a desirable goal, especially considering that hypertension is associated with an increased risk of developing kidney damage, which may eventually lead to end-stage renal disease and a higher mortality. Dihydropyridine calcium channel blockers (CCBs) are widely used in the field of hypertension therapy but the different renal effects of the various CCBs have been poorly explored to date.

Scope:

This review will discuss available evidence on the renal effects of two calcium channel blockers: amlodipine and lercanidipine, on the basis of clinical data.

Methods:

MEDLINE and EMBASE were searched for inclusion of relevant studies. No limitations in time were considered.

Results:

Results from preclinical and clinical studies suggest that amlodipine is overall less effective in terms of renal protection when compared with other antihypertensive tested agents. Its beneficial effect in retarding the progression of renal disease is achievable only when combined with a blocker of the renin–angiotensin system. Conversely lercanidipine seems to provide renal protection in a similar way to ACE inhibitors, probably thanks to its mechanism of action which acts directly on the afferent and efferent renal arterioles.

Conclusions:

Treatment of hypertension with CCBs should take into consideration the special effects of each single agent at different levels; lercanidipine for example may play a useful role in the management not only of hypertension but also in renal protection of hypertensive patients.

Keywords::

• Calcium channel blockers
• Chronic kidney disease
• Dihydropyridines
• Microalbuminuria
• Renal microcirculation

Transparency

Declaration of funding

Editorial assistance for the preparation of this manuscript was funded by Recordati.

Declaration of financial/other relationships

M.B. has disclosed that he has been a speaker for Recordati.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Editorial assistance for the preparation of this manuscript was provided by Luca Giacomelli PhD and Ambra Corti on behalf of Content Ed Net.

 Notice of Correction

 The version of this article published online ahead of print on 27 SEP 2013 contained a minor error in the “Rahman et al.: the ALLHAT Study” section. The error has been corrected for this version.