Protective Effects of Amlodipine Pretreatment on Contrast-Induced Acute Kidney Injury And Overall Survival In Hypertensive Patients

Abstract

Backgroud: Contrast-induced acute kidney injury (CI-AKI) is the most common adverse reaction caused by contrast media, which has been reported to prolong hospitalization and increase mortality and morbidity. The hypertensive population has proved susceptible to CI-AKI. Unfortunately, no therapeutic has been shown to prevent and cure CI-AKI effectively. A few studies have shown the protection of amlodipine on renal function, but the relationship between amlodipine and CI-AKI in hypertensive group is unknown, we aimed to study the effects of amlodipine on CI-AKI and overall survival in a large Chinese hypertensive cohort. Methods: A retrospective, matched, cohort study was conducted among adults hospitalized at the Third Xiangya Hospital of Central South University from October 2007 to May 2017. CI-AKI was the primary end point of the trial, time-related all-cause mortality (including in-hospital) and length of hospital stay were the secondary end points. Propensity Score Matching was used to reduce the effect of selection bias and potential confounding. Results: 868 patients with and 1,798 ones without amlodipine before contrast administration were included. The incidence of CI-AKI was 10.50%. The unadjusted, adjusted, and propensity-score matched incidence of CI-AKI were lower in patients treated with amlodipine (OR, 0.650; P = 0 .003; OR, 0.577; P = 0.007; OR, 0.687; P = 0.015, respectively), and the same results were found in the subgroups of diabetes, chronic kidney disease (CKD), non-CKD, low-osmolar, and elderly. Moreover, amlodipine reduced hospital stay, whether matched or not (7.08 ± 7.28 vs 7.77 ± 7.82, P = 0.027, before matching; vs 7.81 ± 7.58, P = 0.040, after matching). 1,046 patients finished follow-up including 343 amlodipine users and 703 non-users. The overall mortality was significantly lower among amlodipine users (10.79%) than controls (16.07%), the significant difference was found in survival between them (P = 0.024, log-rank test), amlodipine was associated with longer overall survival [HR, 0.623; 95% CI (0.430-0.908), P = 0.014]. Conclusion:In conclusion, we first found amlodipine treatment before contrast exposure played a role in protecting hypertensive patients from CI-AKI and prolonging survival.

Comparison of the Ameliorating Effects of Valsartan and Amlodipine on Vascular Endothelial Dysfunction and Oxidative Stress in Elderly Patients with Type H Hypertension

“…Studies have shown that amlodipine can promote the release of vascular endogenous factors and can play a protective function of vascular endothelium. Compared with most antihypertensive drugs, it inhibits calcium ion slow channel transmembrane influx into vascular smooth muscle and myocardium with fewer side effects and a longer half-life [ 5 ]. The results of this study showed that after 24 weeks of valsartan or amlodipine treatment, compared with the baseline value, the 24 h mean SBP, SDP, 24HSBP, and DBP variation coefficient of the two groups of patients were significantly decreased, and there was no significant difference between the two groups, which suggested that valsartan and amlodipine have good clinical efficacy in the treatment of elderly H-type hypertension.…”

Blood Pressure Control Following Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: Insights from a Triple‐Blind, Randomized, Clinical Trial

“…The L-type CCB amlodipine may be effective in preventing drug-induced nephrotoxicity and AKI in patients with hypertension. 10,11 In contrast, with the vasodilator effect on the efferent arteriole, RAS inhibitors could lower hydrostatic pressure inside the glomeruli, reduce renal perfusion, and thus reduce the glomerular filtration rate (GFR), which, coupled with other factors, could contribute to AKI. 12 According to the latest Renal Association guideline on AKI, 13 ACEIs and ARBs could harm kidney function and should be discontinued when AKI develops.…”

Reno protective role of amlodipine in patients with hypertensive chronic kidney disease

“…ALM safely lowers SBP in hypertensive hemodialysis patients and has a favorable influence on CV outcomes[ 48 ]. The link between ALM and contrast-induced acute kidney injury is uncertain, although a retrospective, matched cohort investigation in a large Chinese hypertension population found that ALM medication prior to contrast exposure protected hypertensive patients from contrast-induced acute kidney injury and increased survival[ 49 ]. Results from several trials proving the superiority of ALM in decreasing hypertensive CKD are shown below and summarized in Table 3 .…”