Azelnidipine and glucose tolerance: possible indications and treatment selection for hypertensive patients with metabolic disorders

Abstract

Azelnidipine is a unique dihydropyridine calcium channel blocker with selectivity for L-type calcium channels that has been launched for the treatment of hypertension. Azelnidipine exhibits long-acting blood pressure-lowering effects without increasing heart rate. High blood pressure is associated with many metabolic disorders, including glucose intolerance and insulin resistance. Antihypertensive medications that interfere with various steps in the renin-angiotensin system improve glucose tolerance and insulin resistance; however, the effects of calcium channel blockers on glucose metabolism and insulin resistance remain controversial. Recent studies have demonstrated that azelnidipine could improve insulin resistance and glucose tolerance by potentially inhibiting sympathetic nerve activity. In addition, azelnidipine exhibits anti-inflammatory and anti-oxidative effects, suggesting that it is a beneficial antihypertensive agent with anti-atherogenic and cardioprotective effects for the treatment of not only hypertensive patients with glucose intolerance, but also those with metabolic disorders.

Renoprotective effects of renin–angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients

“…[ 2 – 4 ] In particular, when a renin–angiotensin–aldosterone system (RAAS) inhibitor is used, combining this type of medication with a calcium channel blocker (CCB) or a thiazide diuretic improves patients’ prognosis. [ 2 – 4 ] The combination of an RAAS inhibitor and a CCB has been recommended since CCBs have shown potent antihypertensive and cardiovascular protective effect, [ 2 – 4 , 7 ] while having minimal effects on metabolism, [ 8 , 9 ] thus decreasing blood pressure safely and synergistically. [ 10 ] In contrast, the combination of an RAAS inhibitor and a diuretic has been recommended as diuretics reduce plasma volume and cardiac output.…”