DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20174380

Antiproteinuric effects of cilnidipine and amlodipine as add on therapy in hypertensive patients with chronic renal disease: a comparative study

Y. Nisha Maheswari, B. Meenakshi, V. Ramasubramanian, J. Ezhil Ramya

Abstract


Background: Cilnidipine is a dual blocker of L type and N type calcium channel and dilates both afferent and efferent arterioles. Hence it increases renal blood flow and reduces glomerular pressure ultimately reducing proteinuria. Thus, it may exert renoprotective effects. The present study was designed to compare the antiproteinuric effects of cilnidipine and amlodipine in hypertensive patients with chronic kidney disease as add on therapy to patients on losartan.

Methods: This is a randomized, open label, prospective, parallel group study conducted in the out patient Department of Nephrology. The trial enrolled Diabetic CKD patients with hypertension and with spot urine protein creatinine ratio (PCR) ≥0.2 who were being treated with T. Losartan 50mg/day for >2 months. The subjects were then randomly assigned to 2 groups to receive either cilnidipine 10-20mg/day (Group A-46) or amlodipine 5-10mg/day (Group B- 50). The drugs were given for a duration of 6 months for each patient. The dose of losartan (50mg/day) was not adjusted throughout the study.

Results: After 6 months, a significant reduction in systolic and diastolic blood pressure was seen in both the groups. The decrease in urinary protein creatinine ratio was significantly higher in cilnidipine group rather than amlodipine group. Thus, cilnidipine exerted greater antiproteinuric effect than amlodipine.

Conclusions: Cilnidipine has antihypertensive effect equivalent to amlodipine but addition of cilnidipine rather than amlodipine to losartan decreased urine protein excretion in diabetic chronic kidney disease patients.


Keywords


Amlodipine, Chronic kidney disease, Cilnidipine, Losartan, Proteinuria

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References


Longo, Fauci, Kasper. Harrison’s principles of internal medicine. Mc Graw Hill publication; 18th Edition; Volume 2; chapter 280:2308-2326.

Remuzzi G, Schieppati A, Ruggenenti P. Nephropathy in patients with type 2 diabetes. N Engl J Med. 1997;346:1145-51.

National kidney foundation. K. DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43:S1-290.

Lavermann GD, Henning RH, De Jong PE, Navis G, Zeeuw D. Optimal Antiproteinuric dose of losartan in nondiabetic patients with nephritic range proteinuria. Am J Kidney Dis. 2001;38:1381-4.

Japanese Society of Hypertension. Japanese Society of Hypertension Guidelines for Management of Hypertension (JSH 2004). Hypertens Res. 2006;29:S1-S105.

Hakka T, Takeda K, Shiotsu Y, Sugishita C. Switching to an L/N- type calcium channel blocker shows renoprotective effects in patients with chronic kidney disease: the Kyoto Cilnidipine study. The Journal of International Medical Research. 2012;40:1417-28.

Koshy S, Bakris GL. Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers. Cardiovasc Drugs Ther. 2000;14:295-301.

Kloke HJ, Branten AJ, Huysmans FT, Wetzels JF. Antihypertensive treatment of patients with proteinuric renal diseases: risks or benefits of calcium channel blockers?. Kidney International. 1998;53(6):1559-73.

Satomura A, Fujita T, Fuke Y, Wada Y, Matsumoto K. Change of Glomerular Hemodynamics in Patients with Advanced Chronic Kidney Disease after Cilnidipine Therapy. Open Clinical Chemistry Journal. 2009;2:31-6.

Fujita T, Ando K, Nishimura H. Antiproteinuric effect of the calcium channel blocker cilnidipine added to renin- angiotensin inhibition in hypertensive patients with chronic renal diseases. Kidney International. 2007;72:1543-9.

Gai M, Motta D, Giunti S, Fop F, Masini S, Mezza E, et al. Comparison between 24‐h proteinuria, urinary protein/creatinine ratio and dipstick test in patients with nephropathy: Patterns of proteinuria in dipstick‐negative patients. Scandinavian Journal of Clinical and Laboratory Investigation. 2006 Jan 1;66(4):299-308.

Zaman ZA, Kumari V. Comparison of the effects of amlodipine and cilnidipine on blood pressure, heart rate, proteinuria and lipid profile in hypertensive patients. Int J Basic Clin Pharmacol. 2013;2:160-4.