We examined a novel therapeutic approach for
hypertension, a small-molecule direct inhibitor of smooth muscle
myosin,
CK-2018448 (CK-448), which is an N,N'-alkylurea (U.S. Patent Publication 2009-0275537 A1) in conscious dogs with
renal hypertension and compared its efficacy with that of a
calcium channel blocker,
amlodipine. Dogs were instrumented with a miniature left ventricular pressure gauge, an aortic pressure
catheter, and ultrasonic flow probes in the ascending aorta and renal and iliac arteries for measurement of cardiac output and regional blood flow. In the hypertensive state, mean arterial pressure increased from 101 ± 3.8 to 142 ± 1.9 mm Hg. At the doses selected,
CK-448 and
amlodipine increased cardiac output similarly (30 ± 11% versus 33 ± 6.4%) and similarly reduced mean arterial pressure (-22 ± 3.6% versus -16 ± 3.4%) and total peripheral resistance (-36 ± 5.9% versus -37 ± 5.8%).
CK-448 had the greatest
vasodilator effect in the renal bed, where renal blood flow increased by 46 ± 9.0%, versus 11 ± 3.4% for
amlodipine (p < 0.01). CK-488 produced significantly less vasodilation in the limb, where iliac blood flow did not change; in contrast, it rose by 48 ± 12% with
amlodipine (p < 0.01). The minimal effects on limb blood flow could limit the development of peripheral
edema, an adverse side effect of Ca(2+) channel blockers. In addition, in a rodent model of
hypertension,
oral administration of a smooth muscle
myosin inhibitor resulted in a sustained
antihypertensive effect. Thus, the smooth muscle
myosin inhibitor's preferential effect on renal blood flow makes this
drug mechanism particularly appealing, because many patients with
hypertension have
renal insufficiency, and patients with
heart failure could benefit from afterload reduction coupled with enhanced renal blood flow.