Renal Effects of Felodipine in Hypertension

Leonetti, Gastone; Terzoli, L.; Rupoli, L.; Gradnik, R.; Zanchetti, Alberto

doi:10.2165/00003495-198700343-00013

Cited by 17 publications

(6 citation statements)

References 7 publications

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“…Although urinary 24-hour excretion of sodium is not increased when measured after about 1 week of treatment with calcium entry blockers, a negative sodium balance within the first days is obtained with verapamil, 1 felodipine, 4 and nitrendipine treatment. 3 -5 Following antihypertensive treatment with nicardipine for 2 months in humans, Young et al 18 observed unaltered excretion of sodium within 5 hours after the moming dose and a concomitant increase in diuresis.…”

mentioning

confidence: 94%

Repetitive natriuresis and blood pressure. Long-term calcium entry blockade with isradipine.

et al. 1987

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SUMMARY The long-term effects (3.5 months) of a new calcium entry blocker of the 1-4-dihydropyridine class, isradipine , on renal hemodynamics and excretional parameters were investigated in 10 essential hypertensive subjects (World Health Organization Classes I and II). Blood pressure and renal vascular resistance fell significantly (p < 0.001), and a slight increase in glomerular filtration rate and renal plasma flow was seen (p<0.05). Output of fluid from the proximal tubules, measured as clearance of lithium and uric acid, increased significantly (p<0.01 and p<0.05, respectively), and a compensatory increase in absolute reabsorption of sodium beyond the proximal tubular level accompanied by an increase in clearance of potassium was noted. A 40% increase in the resultant clearance of sodium (p<0.01) and an increase in diuresis (p<0.05) followed the morning dose of isradipine after 3.5 months of treatment. Changes in blood pressure were significantly correlated with changes in absolute proximal reabsorption of sodium (r = 0.81), excretion of sodium (r = -0.64), and diuresis (r = -0.80). Thus, the natriuretic properties of calcium entry blockers may be more important for the long-term antihypertensive effect than the vasodilator effect per se. A model for renal sodium handling following treatment with calcium entry blockers was proposed. Although a causal relationship is not implied, isradipine induced a sustained, repetitive postdose effect on proximal fluid output, net natriuresis, and diuresis, that was intimately related to the long-term blood pressureregulating response.

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confidence: 94%

Repetitive natriuresis and blood pressure. Long-term calcium entry blockade with isradipine.

et al. 1987

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“…Calcium antagonists are natriuretic and diuretic after acute administration [17][18][19][20], and prelimary results support the view of a more prolonged natriuretic action [21][22][23][24]. Furthermore, thiazide diuretics do not appear to be additive to nifedipine when the latter is maximally effective in patients with essential hypertension [11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 88%

“…For instance, a high sodium intake enhances their blood-pressure lowering effect and diuretics appear to have little or no additive effect on blood pressure in patients already on nifedipine treatment when the latter is maximally effective [11][12][13][14]. Furthermore, dihydropyridine calcium antagonists, either when given acutely [17][18][19][20] or after chronic administration [21][22][23][24], exert a natriuretic effect.Their efficacy is also related to the severity of hypertension, as they are more effective the higher the blood pressure is [8]. However, it is not yet clear whether this characteristic is responsible for the greater effect on a high sodium intake, as the starting blood pressure is often higher than when on a low sodium intake.…”

mentioning

confidence: 99%

Calcium-channel blockers and sodium intake: A controlled study in patients with essential hypertension

Galletti

Strazzullo

Cappuccio

et al. 1989

Cardiovasc Drug Ther

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Thirteen patients with mild to moderate essential hypertension and whose average supine blood pressure with no treatment was 165/104 mmHg were studied as inpatients for 3 consecutive one-week periods on different sodium intakes. On the last day of each dietary period, they received a single, 20-mg nitrendipine tablet and blood pressure was monitored every 10 minutes for 2 hours after drug administration. Nitrendipine significantly lowered blood pressure independently of the level of sodium intake, and the maximum blood-pressure lowering effect was achieved approximately 1 hour after the dose. The blood-pressure lowering effect of nitrendipine was greater on high sodium intake as compared to low sodium intake (p less than 0.02), and it was also greater with higher initial blood pressures. However, the sodium-related effect on blood pressure was, at least in part, independent of the pretreatment blood pressure. These results suggest that calcium antagonists, such as nitrendipine, are effective in reducing blood pressure in patients with essential hypertension and could be drugs of choice in those who are unable to restrict their salt intake.

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“…First, by decreasing peripheral vascular resistance and cardiac output (depending on which agent is chosen), they address the pathophysiological mechanisms of arterial hypertension in ESRD (see previous section [101]. Second, they do not have any deleterious effects on lipids, glucose metabolism and uric acid [99,102,103]; nifedipine may even increase the 25 hydroxyvitamin D plasma levels [104] and improve peripheral glucose utilization [105]. The diuretic effect of 1,4dihydropyridines [105] has so far not been demonstrated in severe renal failure.…”

Section: Calcium Antagonistsmentioning

confidence: 99%

“…Second, they do not have any deleterious effects on lipids, glucose metabolism and uric acid [99,102,103]; nifedipine may even increase the 25 hydroxyvitamin D plasma levels [104] and improve peripheral glucose utilization [105]. The diuretic effect of 1,4dihydropyridines [105] has so far not been demonstrated in severe renal failure. The new 1,4-dihydrophyridines are potent vasodilators and may be preferable to minoxidil and hydralazine, which are associated with water retention and a high cardiac output [106].…”

Section: Calcium Antagonistsmentioning

confidence: 99%

Cardiac Dysfunction in Chronic Uremia

Parfrey¹,

Harnett²

1992

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Renal Effects of Felodipine in Hypertension

Cited by 17 publications

References 7 publications

Repetitive natriuresis and blood pressure. Long-term calcium entry blockade with isradipine.

Repetitive natriuresis and blood pressure. Long-term calcium entry blockade with isradipine.

Calcium-channel blockers and sodium intake: A controlled study in patients with essential hypertension

Cardiac Dysfunction in Chronic Uremia

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