The role of calcium antagonists in chronic kidney disease

The incidence of end-stage renal disease (ESRD) secondary to diabetes and hypertension has increased and is a major worldwide public-health problem. The presence of chronic kidney disease (CKD) is an important factor to consider when selecting antihypertensive medications. Specifically, if proteinuria or albuminuria is present, agent selection to low blood pressure should ideally also lower albuminuria significantly. An increase in albuminuria is a sensitive and independent predictor of CKD progression as many post hoc analyses of clinical trials demonstrate failure to lower albuminuria even with blood pressure reduced does not provide optimal slowing of nephropathy progression. This paper reviews the effects of calcium antagonists (CAs) on hypertension, proteinuria and CKD progression. The totality of the data supports the concept that in early stage CKD with either no or low levels of microalbuminuria all CAs behaves similarly. However, in advanced proteinuric nephropathy nondihydropyridine CAs provide significantly greater reductions in albuminuria than dihydropyridine CAs. Moreover, they are preferred in that setting to assure blood pressure as well as albuminuria reduction. Achieving a blood pressure of < 130/80 mm Hg utilizing a renin angiotensin system (RAS) blocker plus nondihydropyridine CAs as part of the regimen to lower blood pressure is recommended by current CKD guidelines for treating hypertensive CKD patients with proteinuria.