Benidipine reduces albuminuria and plasma aldosterone in mild-to-moderate stage chronic kidney disease with albuminuria

Abstract

Benidipine inhibits both L-and T-type Ca channels, and has been shown to dilate the efferent arterioles as effectively as the afferent arterioles. In this study, we conducted an open-label and randomized trial to compare the effects of benidipine with those of amlodipine on blood pressure (BP), albuminuria and aldosterone concentration in hypertensive patients with mild-tomoderate stage chronic kidney disease (CKD). Patients with BPX130/80 mm Hg, with estimated glomerular filtration rate (eGFR) of 30-90 ml min À1 per 1.73 m 2 , and with albuminuria430 mg per g creatinine (Cr), despite treatment with the maximum recommended dose of angiotensin II receptor blockers (ARBs) were randomly assigned to two groups. Patients received either of the following two treatment regimens: 2 mg per day benidipine, which was increased up to a dose of 8 mg per day (n¼52), or 2.5 mg per day amlodipine, which was increased up to a dose of 10 mg per day (n¼52). After 6 months of treatment, a significant and comparable reduction in the systolic and diastolic BP was observed in both groups. The decrease in the urinary albumin to Cr ratio in the benidipine group was significantly lower than that in the amlodipine group. Although plasma renin activity was not different in the two groups, plasma aldosterone levels were significantly decreased in the benidipine group. Moreover, urinary Na/K ratio was significantly decreased in the benidipine group but remained unchanged in the serum. It may be concluded that benidipine results in a greater reduction of plasma aldosterone and albuminuria than amlodipine, and that these effects are independent of BP reduction.

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

“…Our data with lower doses of spironolactone or eplerenone might be more practical. Calcium channel blockers decrease aldosterone synthesis in human adrenocortical cells [24] and in hypertensive patients [25]. Nakamura et al reported that eplerenone potentiates the protective effects of amlodipine against cardiovascular injury in salt-sensitive hypertensive rats independently of blood pressure [26].…”

Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

“…In hypertensive patients with mild to moderate chronic kidney disease. 13 After 48 weeks of treatment a significant and comparable reduction in systolic and diastolic BP in both the groups (p=<0.05).…”

Cardiac hypertrophy in chronic kidney disease—role of Aldosterone and FGF23

“…It is now well established that certain types of calcium channel blockers, including efonidipine [70], benidipine [71], azelnidipine [72], and cilnidipine [73], inhibit aldosterone synthesis in adrenocortical cells. Furthermore, clinical studies show that these agents decrease serum aldosterone levels in hypertensive patients [74][75][76][77][78][79]. Of interest, these calcium channel blockers are endowed with the ability to inhibit not only L-type but also T-type (efonidipine, benidipine, azelnidipine) or N-type calcium channels (benidipine, cilnidipine), whereas conventional calcium channel blockers such as nifedipine and amlodipine exert inhibitory action solely on L-type calcium channels [80][81][82].…”