Cilnidipine, a dual L-/N-type calcium channel blocker, dilates both efferent and afferent arterioles and is renoprotective. Our multi-center, open-labeled, and randomized trial compared the antiproteinuric effect of cilnidipine with that of amlodipine in hypertensive patients with kidney disease. A group of 339 patients, already receiving renin-angiotensin system inhibitor treatment, were randomly assigned to cilnidipine or amlodipine. The primary endpoint was a decrease in the urinary protein to creatinine ratio. After 1-year of treatment, systolic and diastolic blood pressures were significantly reduced in both groups which did not differ between them. The urinary protein to creatinine ratio significantly decreased in the cilnidipine compared to the amlodipine group. Cilnidipine exerted a greater antiproteinuric effect than amlodipine even in the subgroup whose blood pressure fell below the target level. This study suggests that cilnidipine is superior to amlodipine in preventing the progression of proteinuria in hypertensive patients when coupled with a renin-angiotensin system inhibitor.

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Abstract-We reported previously that ATP2B1 was one of the genes for hypertension receptivity in a large-scale Japanese population, which has been replicated recently in Europeans and Koreans. ATP2B1 encodes the plasma membrane calcium ATPase isoform 1, which plays a critical role in intracellular calcium homeostasis. In addition, it is suggested that ATP2B1 plays a major role in vascular smooth muscle contraction. Because the ATP2B1 knockout (KO) mouse is embryo-lethal, we generated mice with vascular smooth muscle cell-specific KO of ATP2B1 using the Cre-loxP system to clarify the relationship between ATP2B1 and hypertension. The KO mice expressed significantly lower levels of ATP2B1 mRNA and protein in the aorta compared with control mice. KO mice showed significantly higher systolic blood pressure as measured by tail-cuff method and radiotelemetric method. Similar to ATP2B1, the expression of the Na 1 In the Millennium Genome Project 2 we identified single nucleotide polymorphisms located upstream or within the ATP2B1 gene as strong susceptible polymorphisms for hypertension in Japanese. Some of these findings have been replicated in individuals of European descent in the Global Blood Pressure Genetics sample and have also been validated in other studies in individuals of European descent, 3 Koreans, 4-6 and Japanese. 7 The single nucleotide polymorphisms of ATP2B1 identified in these studies showed a significant association with hypertension in various large-scale study populations with different methods, genome-wide association study in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium and the Korean study and candidate gene analysis in our previous study. However, the functional roles of ATP2B1 in blood pressure control have not yet been proven in vivo. The ATP2B1-null mutant mouse has been reported to be embryolethal 8 ; thus, we need to make a conditional knockout (KO) mouse model of ATP2B1 using the Cre-loxP system to reveal the function of the gene. Because the ATP2B1 gene encodes one of the calcium pumps and plays an important role in contraction of bladder smooth muscle, 9 we selected vascular smooth