L/N-type calcium channel blocker cilnidipine added to renin-angiotensin inhibition improves ambulatory blood pressure profile and suppresses cardiac hypertrophy in hypertension with chronic kidney disease.

Abstract

Ambulatory blood pressure (BP) and heart rate (HR) profile are proposed to be related to renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In this study, we examined the beneficial effects cilnidipine, a unique L/N-type calcium channel blocker (CCB), in addition to renin-angiotensin system inhibitors, on ambulatory BP and HR profile, as well as cardiorenal function in hypertensive CKD patients. Forty-five patients were randomly assigned to the cilnidipine replacement group (n = 21) or the control CCBs group (n = 24) during a 24-week active treatment period. Although clinical BP values were similar in the cilnidipine and control CCBs groups after the treatment period, the results of ambulatory BP monitoring showed that the 24-h and daytime systolic BP levels in the cilnidipine group were significantly lower compared with the control group after the study. Furthermore, the left ventricular mass index (LVMI) was significantly decreased in the cilnidipine group compared to the control group after the study (LVMI, 135.3 ± 26.4 versus 181.2 ± 88.4, p = 0.031), with a significant difference in the changes in the LVMI between the cilnidipine and control groups (change in LVMI, -12.4 ± 23.7 versus 26.2 ± 64.4, p = 0.007). These results indicate that cilnidipine is beneficial for the suppression of pathological cardiac remodeling, at least partly, via a superior improving effect on ambulatory BP profile compared with control CCBs in hypertensive CKD patients.

• Authors: Tomohiko Kanaoka, Kouichi Tamura, Hiromichi Wakui, Masato Ohsawa, Kengo Azushima, Kazushi Uneda, Ryu Kobayashi, Tetsuya Fujikawa, Yuko Tsurumi-Ikeya, Akinobu Maeda, Mai Yanagi, Yoshiyuki Toya, Satoshi Umemura
• Journal: International journal of molecular sciences (Int J Mol Sci) Vol. 14 Issue 8 Pg. 16866-81 (Aug 16 2013) ISSN: 1422-0067 [Electronic] Switzerland
• PMID: 23959116 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin Receptor Antagonists
• Antihypertensive Agents
• Calcium Channel Blockers
• Calcium Channels, L-Type
• Calcium Channels, N-Type
• Dihydropyridines
• cilnidipine

Topics

• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (pharmacology, therapeutic use)
• Antihypertensive Agents (pharmacology, therapeutic use)
• Blood Pressure (drug effects)
• Blood Pressure Monitoring, Ambulatory
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Calcium Channels, L-Type (metabolism)
• Calcium Channels, N-Type (metabolism)
• Cardiomegaly (drug therapy, physiopathology)
• Dihydropyridines (pharmacology, therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Hypertension (drug therapy, physiopathology)
• Male
• Middle Aged
• Renal Insufficiency, Chronic (drug therapy, physiopathology)
• Renin-Angiotensin System (drug effects)
• Treatment Outcome