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.

Effects of the oriental herbal medicine Bofu-tsusho-san in obesity hypertension: A multicenter, randomized, parallel-group controlled trial (ATH-D-14-01021.R2)

“…HR variability, which is composed of the CV of the HR values, is also calculated as the within-subject SD of all the HR values divided by the average HR. BP and HR artifacts during monitoring were defined according to the criteria reported in our previous studies and were omitted from the analysis [18,19].…”

Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis

“…Nine studies enrolled patients with preserved kidney function (GFR460 ml min − 1 1.73 m − 2 ) 22,24,26,[28][29][30]32,33,36 and eight studies enrolled patients with low GFR (o60 ml min − 1 1.73 m − 2 ). 23,25,27,31,34,35,37,38 At enrollment, hypertension was well controlled in only 3 studies 22,28,34 and poorly controlled in the remaining 14 studies. The GFR was assessed in 15 studies.…”

“…25,37,38 Proteinuria was reported instead of albuminuria in five studies. 23,27,30,34,35 Two studies did not specify inclusion criteria regarding proteinuria. 24,32 According to the Jadad scale, all of the studies were of fair quality ( Table 1).…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Blockers of the RAAS were prescribed in both the intervention and control groups in all included studies. Characteristics of the individual trials are displayed in Table 1.…”

“…The GFR was assessed in 15 studies. The GFR was estimated using the Cockcroft-Gault equation in one study 34 and either the modified estimated GFR (eGFR) estimating equation developed for Japanese persons by the Japanese Society of Nephrology 39 in nine studies 26,27,[31][32][33][35][36][37][38] or the Modification of Diet in Renal Disease Study equation for Japanese patients 40 in four trials. 24,25,29,30 One study did not specify the calculation method.…”