Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients

Abstract

Background. Hypertensive haemodialysis patients may be at a high risk for cardiovascular events. This study was undertaken to ascertain whether the calcium channel blocker amlodipine reduces mortality and cardiovascular events in these high-risk patients.Methods. We evaluated the effects of amlodipine on cardiovascular events in 251 hypertensive haemodialysis patients in an investigator-designed, prospective, randomized, double-blind, placebo-controlled, multicenter trial. One hundred and twenty-three patients were randomly assigned to amlodipine (10 mg once daily) and 128 to placebo. The primary endpoint was mortality from any cause. The secondary endpoint was a composite variable consisting of mortality from any cause or cardiovascular event. Analysis was by intention-to-treat. The trial was registered with ClinicalTrials.gov (number NCT00124969).Results. The median age of patients was 61 years (25% percentile − 75% percentile, 47–69), and the median follow-up was 19 months (8–30). Fifteen (12%) of the 123 patients assigned to amlodipine and 22 (17%) of the 128 patients assigned to placebo had a primary endpoint [hazard ratio 0.65 (95% CI 0.34–1.23); P = 0.19]. Nineteen (15%) of the 123 haemodialysis patients assigned to amlodipine and 32 (25%) of the 128 haemodialysis patients assigned to placebo reached the secondary composite endpoint [hazard ratio 0.53 (95% CI 0.31–0.93); P = 0.03].Conclusion. Amlodipine safely reduces systolic blood pressure and it may have a beneficial effect on cardiovascular outcomes in hypertensive haemodialysis patients.

Attending Rounds

“…This patient was on lisinopril and metoprolol. Amlodipine is a reasonable third-line agent given its long half-life, and at least in one randomized prospective clinical trial in ESRD patients, it did not increase the incidence of IDH (16). We avoid short-acting drugs, such as clonidine, that need to be administered frequently whenever possible.…”

Hypertension in cardiac transplant recipients

“…Уменьшение протеинурии на фоне приема ам-лодипина было доказано не во всех исследованиях, но как показали результаты исследования Tepel M и совт., у больных хроническими заболеваниями почек, находящимися на гемодиализе, назначение амлодипина сопровождается значительным сниже-нием риска развития нежелательных сердечно-со-судистых событий [60].…”

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

“…The cardioselective β-blockers (β₁-blockers) such as metoprolol and atenolol have been studied in patients with essential hypertension with normal renal function, hypertension along with diabetic nephropathy and ESRD with dialysis and demonstrated that neither metoprolol nor atenolol produce significant reduction in GFR or renal blood flow while effectively lowering blood pressure in patients with essential hypertension, although both can increase renovascular resistance [32,33]. Studies with metoprolol and atenolol in patients with ESRD on chronic dialysis or after kidney transplantation have demonstrated no adverse effects on renal hemodynamics [34,35].…”