Pediatric Nephrology

, Volume 20, Issue 9, pp 1208–1213 | Cite as

The role of calcium antagonists in patients with chronic renal failure

Editorial Commentary

Abstract

The objective of antihypertensive treatment in patients with chronic renal failure, many of whom have elevated blood pressure levels, is to reduce cardiovascular events and to slow down the progression of kidney function impairment. Calcium antagonists have been shown to be effective and safe antihypertensive drugs in patients from different age groups, including children. On the basis of numerous studies, one may conclude that the main benefit of antihypertensive therapy is because of the blood pressure lowering effect per se and that calcium antagonists do not differ from other antihypertensive drugs in the ability to prevent cardiovascular complications of hypertension. In particular, calcium antagonists are not inferior to other groups of antihypertensive agents in the prevention of coronary artery disease. There is, however, now evidence from controlled clinical trials that drugs interfering with the renin–angiotensin system are more beneficial than other antihypertensive agents in patients with chronic renal failure. Thus, several studies have demonstrated that ACE-inhibitors and, in patients with type-2 diabetic nephropathy, AT 1-antagonists are superior to other classes of antihypertensive drugs, including calcium antagonists, in delaying the progression of renal insufficiency. Therefore, in hypertensive patients with chronic renal failure antihypertensive treatment should be initiated with a drug that inhibits the renin–angiotensin system.

Keywords

Calcium antagonists Renal failure Hypertension Cardiovascular events Nephroprotection 

References

  1. 1.
    US Renal data system (1999) USRDS 1999 Annual Data Report, Bethesda, MD, USAGoogle Scholar
  2. 2.
    Mann JFE, Gerstein HC, Pogue J, Bosch J, Yusuf S (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Int Med 134:629–636PubMedGoogle Scholar
  3. 3.
    Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warnold L, Wedel H, Zanchetti A (2001) Renal function and intensive lowering of blood pressure in hypertensive participants of the Hypertension Optimal Treatment (HOT) study. J Am Soc Nephrol 12:218–225PubMedGoogle Scholar
  4. 4.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo jr JL, Jones DW, Materson BJ, Oparil S, Wright jr JT, Roccella EJ (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 289:2560–2572CrossRefPubMedGoogle Scholar
  5. 5.
    Zanchetti A, Cifkova R, Fagard R, Kjeldsen S, Mancia G, Poulter N, Rahn KH, Rodicio JL, Ruilope LM, Staessen J, van Zwieten P, Waeber B, Williams B (2003) 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21:1011–1053PubMedGoogle Scholar
  6. 6.
    Cristofori P, Lanzoni A, Quartaroli M, Pastorino AM, Zancanaro C, Cominacini L, Gaviraghi G, Turton J (2000) The calcium-channel blocker lacidipine reduces the development of atherosclerotic lesions in the apoE-deficient mouse. J Hypertens 18:1429–1438CrossRefPubMedGoogle Scholar
  7. 7.
    Zanchetti A, Bond MG, Hennig M, Neiss A, Mancia G, Dal Palu C, Hansson L, Magnani B, Rahn KH, Reid JL, Rodicio J, Safar M, Eckes L, Rizzini P (2002) Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis. Principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation 106:2422–2427CrossRefPubMedGoogle Scholar
  8. 8.
    Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CA (1990) Blood pressure, stroke and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335:827–838CrossRefPubMedGoogle Scholar
  9. 9.
    Turnbull F, Neal B, Algert C, Chalmers J, Woodward M, MacMahon S (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362:1527–1535CrossRefPubMedGoogle Scholar
  10. 10.
    Kestenbaum B, Gillen DL, Sherrard DJ, Seliger S, Ball A, Stehman-Breen C (2002) Calcium channel blocker use and mortality among patients with end-stage renal disease. Kidney Int 61:2157–2164CrossRefPubMedGoogle Scholar
  11. 11.
    Brenner BM, Cooper ME, De Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snappin SM, Zhang Z, Shahinfar S (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345:861–869CrossRefPubMedGoogle Scholar
  12. 12.
    Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I (2001) Renoprotective effect of the angiotensin receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860CrossRefPubMedGoogle Scholar
  13. 13.
    Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers, G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359:995–1003CrossRefPubMedGoogle Scholar
  14. 14.
    Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B, Trenkwalder P, Zanchetti A (2003) The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomised double-blind intervention trial. J Hypertens 21:875–886CrossRefPubMedGoogle Scholar
  15. 15.
    Julius S, Kjeldsen SE, Weber M, Brunner HR, Ekman S, Hansson L, Hua T, Laragh J, McInnes GT, Mitchell L, Plat F, Schork A, Smith B, Zanchetti A (2004) Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 363:2022–2031CrossRefPubMedGoogle Scholar
  16. 16.
    Weber MA, Julius J, Kjeldsen SE, Brunner HR, Ekman S, Hansson L, Hua T, Laragh J, McInnes GT, Mitchell L, Plat F, Schork MA, Smith B, Zanchetti A (2004) Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE trial. Lancet 363:2049–2051CrossRefPubMedGoogle Scholar
  17. 17.
    Yusuf S, Sleight P, Dagenais G, Montague T, Bosch J, Pogue J, Taylor W, Sardo L (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 342:145–153CrossRefPubMedGoogle Scholar
  18. 18.
    Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, Marcantoni C, De Jong PE, De Zeeuw D, Shahinfar S, Ruggenenti P, Remuzzi G, Levey AS (2001) Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. Kidney Int 60: 1131–1140CrossRefPubMedGoogle Scholar
  19. 19.
    Agadoa LY, Appel L, Bakris GL, Beck G, Bourgoignie J, Briggs JP, Charleston J, Cheek DA, Cleveland W, Douglas JG, Douglas M, Dowie D, Faulkner M, Gabriel A, Gassman J, Greene T, Hall Y, Hebert L, Hiremath L, Jamerson K, Johnson CL, Kopple J, Kusek J, Lash J, Lea J, Lewis JB, Lipkowitz M, Massry S, Middleton J, Miller III ER, Norris K, O’Connor D, Ojo A, Phillips RA, Pogue V, Rahman M, Randall OS, Rostand S, Schulman G, Smith W, Thornley-Brown D, Tisher CC, Toto RD, Wright jr JT, Yu S (2001) Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis. A randomized controlled trial. JAMA 285:2719–2728CrossRefPubMedGoogle Scholar
  20. 20.
    Viberti G, Wheeldon NM (2002) Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus. A blood pressure-independent effect. Circulation 106:672–678CrossRefPubMedGoogle Scholar
  21. 21.
    Ruggenenti P, Fassi A, Parvanova Ilieva A, Bruno S, Iliev IP, Brusegan V, Rubis N, Gherardi G, Arnoldi F, Ganeva M, Ene-Iordache B, Gaspari F, Perna A, Bossi A, Trevisan R, Dodesini AR, Remuzzi G (2004) Preventing microalbuminuria in type 2 diabetes. N Engl J Med 351:1941–1951CrossRefPubMedGoogle Scholar
  22. 22.
    Mogensen CE (1982) Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. BMJ 285:685–688PubMedGoogle Scholar
  23. 23.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting- enzyme inhibition on diabetic nephropathy. N Engl J Med 329:1456–1462CrossRefPubMedGoogle Scholar
  24. 24.
    Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, Mustonen J (2004) Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 351:1952–1961CrossRefPubMedGoogle Scholar
  25. 25.
    Maschio G, Alberti D, Janin G, Locatelli F, Mann JFE, Motolese M, Ponticelli C, Ritz E, Zucchelli P (1996) Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 334:939–945CrossRefPubMedGoogle Scholar
  26. 26.
    Ruggenenti P, Perna A, Mosconi L, Matalone M, Garini G, Salvadori M, Zoccali C, Scolari F, Maggiore Q, Tognoni G, Remuzzi G (1997) Randomised placebo-controlled trial of the effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric non-diabetic nephropathy. Lancet 349:1857–1863CrossRefPubMedGoogle Scholar
  27. 27.
    Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, Scolari F, Schena FP, Remuzzi G (1999) Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 354:359–364CrossRefPubMedGoogle Scholar
  28. 28.
    Hilgers KF, Dötsch J, Rascher W, Mann JFE (2004) Treatment strategies in patients with chronic renal disease: ACE-inhibitors, angiotensin receptor antagonists, or both? Pediatr Nephrol 19:956–961CrossRefPubMedGoogle Scholar
  29. 29.
    Wright jr JT, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek DA, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease. Results from the AASK trial. JAMA 288:2421–2431CrossRefPubMedGoogle Scholar
  30. 30.
    Flynn JT, Newburger JW, Daniels SR, Sanders SP, Portman RJ, Hogg RJ, Saul JP (2004) A randomized, placebo-controlled trial of amlodipine in children with hypertension. J Pediatr 145:353–359CrossRefPubMedGoogle Scholar
  31. 31.
    Trachtman H, Frank R, Mahan JD, Portman R, Restaino I, Matoo TK, Tou, C, Kilbaner M (2003) Clinical trial of extended-release felodipine in pediatric essential hypertension. Pediatr Nephrol 18:548–553PubMedGoogle Scholar
  32. 32.
    Yung D, Widlitz AC, Rosenzweig EB, Kerstein D, Maislin G, Barst RJ (2004) Outcomes in children with idiopathic pulmonary arterial hypertension. Circulation 110:660–665CrossRefPubMedGoogle Scholar
  33. 33.
    Scharer K, Alatas H, Bein G (1977) The treatment of renal hypertension with verapamil in childhood. Monatsschr Kinderheilk 125:706–712Google Scholar
  34. 34.
    Egger DW, Deming DD, Hamada N, Perkin RM, Sahney S (2002) Evaluation of the safety of short-acting nifedipine in children with hypertension. Pediatr Nephrol 17:35–40CrossRefPubMedGoogle Scholar
  35. 35.
    Flynn JT, Warnick SJ (2002) Isradipine treatment of hypertension in children: a single center experience. Pediatr Nephrol 17:748–753CrossRefPubMedGoogle Scholar
  36. 36.
    Von Vigier RO, Franscini LMD, Bianda NDF, Pfister R, Aebischer CC, Bianchetti MG (2001) Antihypertensive efficacy of amlodipine in children with chronic renal diseases. J Hum Hypertens 15:387–391CrossRefPubMedGoogle Scholar
  37. 37.
    Wühl E, Mehls O, Schaefer F, and the ESCAPE Trial Group (2004) Antihypertensive and antiproteinuric efficacy of ramipril in children with chronic renal failure. Kidney Int 66:768–776CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2005

Authors and Affiliations

  1. 1.University of Münster Medical SchoolMünsterGermany

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