Effects of L-/N-Type Calcium Channel Blockers on Angiotensin II–Renin Feedback in Hypertensive Patients

Objectives. Cilnidipine, an L-/N-type calcium channel blocker (CCB), has unique organ-protective properties due to suppression of hyperactivity in the sympathetic nervous system and renin-angiotensin system (RAS). In this study, we hypothesized that cilnidipine might exert a renoprotective effect by suppressing the RAS. Methods. A total of 25 hypertensive patients receiving a RAS inhibitor were randomly assigned to a cilnidipine (n = 12) or amlodipine (n = 13) group. The effects of cilnidipine on proteinuria and angiotensin II–renin feedback were assessed. Results. After 6 months of treatment, both systolic and diastolic blood pressures were significantly reduced to a similar extent in both groups. The urine albumin-to-creatinine ratio was significantly lower in the cilnidipine group ( p < 0.05 ) than in the amlodipine group. Amlodipine increased plasma angiotensin I and angiotensin II levels ( p < 0.05 ), whereas cilnidipine did not. Interestingly, the cilnidipine group had a higher ratio of angiotensin-(1–7) (Ang-(1–7)) to angiotensin II in plasma than the amlodipine group ( p < 0.05 ). Conclusions. The L-/N-type CCB cilnidipine, but not amlodipine, decreased urinary albumin excretion in hypertensive patients. Cilnidipine also increased the ratio of Ang-(1–7) to angiotensin II in plasma, which might be one factor underlying its beneficial effects.

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An observational cross-sectional study to determine the effect of telmisartan on reducing microalbuminuria in diabetic hypertensive patients in tertiary care teaching hospital, Central India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20173300 ◽

2017 ◽

Vol 6 (8) ◽

pp. 2082

Author(s):

Santenna Chenchula ◽

Rupesh Gupta ◽

Balakrishnan S. ◽

Akash Vishwe ◽

Pushparaj Gour ◽

...

Keyword(s):

Calcium Channel ◽

Calcium Channel Blockers ◽

Angiotensin Receptor Blockers ◽

Tertiary Care ◽

Channel Blockers ◽

Angiotensin Receptor ◽

Cross Sectional ◽

Hypertensive Patients ◽

Urine Albumin ◽

Receptor Blockers

Background: There are many groups of drugs to decrease microalbuminuria like angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers and direct vasodilators. Among these, ACEI and ARBs are commonly used for this purpose. If side effects occur, ACEI are replaced with ARBs. Many ARBs have been studied for their effect on reducing microalbuminuria, but data on telmisartan with its additional unique properties are scarce in Indian population.Methods: This cross sectional observational study was carried out in a tertiary care centre. We first measured base line urine albumin levels in included patients, 3 months after treatment with telmisartan using ‘hemocue urine albumin analyser’. We collected and compared both baseline and after treatment data of microalbuminuria and analysed in descriptive statistics.Results: A total of 110 patients participated in this study; out of which 10 patients were excluded from the study because they were not available for follow up. As compared to baseline, urine albumin level decreased by 30.42% after 12 weeks treatment with telmisartan (P <0.001).Conclusions: Microalbuminuria is one of the leading cause of end stage renal disease and coronary heart diseases in diabetic hypertensive patients. Drugs like ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers and direct vasodilators are used to prevent these complications. In this present study, we concluded that telmisartan decreases urine albumin excretion around 30.42% from baseline after 12 weeks of treatment.

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Comparison of Blood Pressure Variability Between Losartan and Amlodipine in Essential Hypertension (COMPAS-BPV)

American Journal of Hypertension ◽

10.1093/ajh/hpaa060 ◽

2020 ◽

Vol 33 (8) ◽

pp. 748-755

Author(s):

Jun-Won Lee ◽

Eunhee Choi ◽

Jung-Woo Son ◽

Young Jin Youn ◽

Sung-Gyun Ahn ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Renin Angiotensin System ◽

Office Visit ◽

Home Blood Pressure ◽

Channel Blockers ◽

Hypertensive Patients ◽

Amlodipine Group ◽

Losartan Group ◽

Average Real Variability

Abstract BACKGROUND Antihypertensive therapy using renin–angiotensin system blockers and calcium channel blockers to target blood pressure variability (BPV) has not yet been established. We aimed to compare the ability of losartan and amlodipine to lower BPV and systolic blood pressure (SBP) in essential hypertensive patients. METHODS Patients were randomly assigned either losartan 50 mg or amlodipine 5 mg. Medications were uptitrated and hydrochlorothiazide was added according to protocol for 6 months. The primary endpoint was the office visit-to-visit SD of SBP. The secondary endpoints included average real variability (ARV), office SBP, and home SBP. RESULTS The losartan group (n = 71) and amlodipine group (n = 73) finished the scheduled visits between April 2013 and May 2017. The office visit-to-visit SD of SBP was comparable between the losartan and amlodipine groups (11.0 ± 4.2 vs. 10.5 ± 3.8, P = 0.468). The office visit-to-visit ARV of SBP was significantly elevated in the losartan group (10.6 ± 4.3 vs. 9.1 ± 3.4, P = 0.02). The absolute SBP decrement from baseline to 6 months was similar between groups, although the office mean SBP at 6 months was higher in the losartan group (132.3 ± 12.9 vs. 127.5 ± 9.0 mm Hg, P = 0.011). In home blood pressure analysis, evening day-to-day BPV indexes (SD and ARV) were significantly higher in the losartan group at 6 months. CONCLUSIONS The lowering effect of the office visit-to-visit SD of SBP was similar between losartan and amlodipine. However, the losartan group showed a higher office visit-to-visit ARV of SBP and evening day-to-day home BPV indexes. Therefore, amlodipine may be better to lower BPV in essential hypertensive patients.

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