China
Africa
Explore chapters and articles related to this topic
Hypertension and the kidney
Published in H. Gavras, The Year in Hypertension 2004, 2004
BACKGROUND. Several recent studies have failed to demonstrate the beneficial action of calcium antagonists. A novel DHPCA, efonidipine, which possesses a dilatory action of both afferent and efferent arterioles (therefore sharing the renal microvascular action of ACE inhibitors), is reported to exhibit renal protection in experimental animals. The present study evaluated the effect of efonidipine and ACE inhibitors on BP and proteinuria. A total of 68 hypertensive volunteers with renal impairment (serum creatinine >1.5 mg/dl) or chronic renal parenchymal disease were randomly assigned to efonidipine or ACE inhibitor treatment. Of the 68 patients, 23 were treated with efonidipine and 20 with various ACE inhibitors and these patients were analysed for the 48-week study. Both efonidipine and ACE inhibitors produced similar degrees of BP reduction (efonidipine, from 161 2/93 2 to 142 5/82 2 mmHg; ACE inhibitor, from 163 3/95 2 to 141 5/82 2 mmHg), and maintained creatinine clearance for 48 weeks. Proteinuria tended to decrease in both groups, and a significant reduction was observed in proteinuric patients (>1 g/day) (efonidipine, from 2.7 0.3 to 2.1 0.3 g/day; ACE inhibitor, from 3.0 0.4 to 2.0 0.5 g/day). Of particular interest, efonidipine decreased proteinuria in patients who failed to manifest decreases in SBP. Finally, the incidence of adverse effects, including hyperkalaemia and cough, was less in the efonidipine treated group. Both efonidipine and ACE inhibitors preserved renal function in hypertensive patients with renal impairment. The antiproteinuric effect was more apparent in patients with greater proteinuria. The authors concluded that this particular DHPCA could be a meaningful adjunct to ACE inhibitors or ARBs in patients with proteinuria who require BP management.
Effect of amlodipine, efonidipine, and trichlormethiazide on home blood pressure and upper-normal microalbuminuria assessed by casual spot urine test in essential hypertensive patients
Published in Clinical and Experimental Hypertension, 2018
Miki Hosaka, Ryusuke Inoue, Michihiro Satoh, Daisuke Watabe, Tomohiro Hanazawa, Takayoshi Ohkubo, Kei Asayama, Taku Obara, Yutaka Imai
Amlodipine is a representative CCB that is widely used all over the world. It blocks the L-type calcium channel and dilates the afferent arterioles to a higher degree than the efferent arterioles, which is thought to lead to glomerular hypertension and an increase in UAE (33). Several studies in patients with chronic kidney disease and hypertension found no effect on (18), or even an increase in (34), UACR following treatment with amlodipine. However, in the present study, amlodipine reduced morning UACR among the patients with 30–300 mg/g Cr of spot UACR (Table 2) on the basis of bivariate analysis. This result supports findings reported in previous studies suggesting that amlodipine can reduce microalbuminuria/proteinuria, at least in hypertensive diabetic patients without overt renal disease (35,36). Efonidipine, an L-and T-type CCB, is thought to have a dilating effect on efferent as well as afferent glomerular arterioles. It could be expected that efonidipine can reduce glomerular hypertension and lead to an additional reduction of UACR (33,37) compared with amlodipine (20,37). The uncertain effect of efonidipine on UACR may be due to the relatively small number of study subjects.
Diagnosis and treatment of cardiac iron overload in transfusion-dependent thalassemia patients
Published in Expert Review of Hematology, 2018
Natthaphat Siri-Angkul, Siriporn C Chattipakorn, Nipon Chattipakorn
Currently, most calcium channel blockers used in clinical practice are relatively nonspecific, blocking both L-type and T-type calcium channels, and there are attempts to identify highly selective T-type calcium channel blockers [121]. Several calcium channel blockers, for instance, efonidipine, felodipine, and nitrendipine, have been shown to have considerable degrees of T-type calcium channel blocking preference [121]. Currently, accumulating evidence demonstrates, in preclinical studies, that the T-type calcium channel blocker efonidipine effectively provided cardioprotection in thalassemic mice [17,18,122,123]. These drugs might serve as an interesting intervention to be investigated in TDT patients in future clinical trials.