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Hypertension

Synergy of antihypertensives in elderly patients with CKD

A recent study reports that the combination of an angiotensin-receptor blocker (ARB) and a calcium-channel blocker (versus a high-dose ARB) is associated with improved blood pressure control and reduced cardiovascular, cerebrovascular and heart failure events in an elderly chronic kidney disease population. This finding raises the possibility of using fixed-dose drug combinations to improve efficacy and compliance of antihypertensive medications.

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References

  1. Aronow, W. S. et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J. Am. Coll. Cardiol. 57, 2037–2114 (2011).

    Article  Google Scholar 

  2. Kim-Mitsuyama, S. et al. An angiotensin II receptor blocker–calcium channel blocker combination prevents cardiovascular events in elderly high-risk hypertensive patients with chronic kidney disease better than high-dose angiotensin II receptor blockade alone. Kidney Int. http://dx.doi.org/10.1038/ki.2012.326.

  3. Wald, D. S. et al. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am. J. Med. 122, 290–300 (2009).

    Article  Google Scholar 

  4. Safar, M. E., Protogerou, A. & Blacher, J. Central blood pressure under angiotensin and calcium channel blockade. Hypertension 54, 704–706 (2009).

    Article  CAS  Google Scholar 

  5. Kreutz, R. Olmesartan/amlodipine: a review of its use in the management of hypertension. Vasc. Health Risk. Manag. 7, 183–192 (2011).

    Article  CAS  Google Scholar 

  6. Wang, Y. & Goldhaber, J. I. Return of calcium: Manipulating intracellular calcium to prevent cardiac pathologies. Proc. Natl Acad. Sci. USA 101, 5697–5698 (2004).

    Article  CAS  Google Scholar 

  7. Hansen, P. B. et al. Functional importance of L- and P/Q-type voltage-gated calcium channels in human renal vasculature. Hypertension 58, 464–470 (2011).

    Article  CAS  Google Scholar 

  8. Ferrão, F. M. et al. Exposure of luminal membranes of LLC-PK1 cells to ANG II induces dimerization of AT1/AT2 receptors to activate SERCA and to promote Ca2+ mobilization. Am. J. Physiol. Renal Physiol. 302, F875–F883 (2012).

    Article  Google Scholar 

  9. Weir, M. R. et al. Renal outcomes in hypertensive black patients at high cardiovascular risk. Kidney Int. 81, 568–576 (2012).

    Article  CAS  Google Scholar 

  10. Abe, M. et al. Additive antioxidative effects of azelnidipine on angiotensin receptor blocker olmesartan treatment for type 2 diabetic patients with albuminuria. Hypertens. Res. 34, 935–941 (2011).

    Article  CAS  Google Scholar 

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Acknowledgements

J. R. Sowers' work is supported by NIH (R01 HL73101-08 and R01 HL107910-03) and the Veterans Affairs Merit System 0018. The authors would like to thank B. Hunter (Administrative Assistant, University of Missouri) for editorial assistance.

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Correspondence to James R. Sowers.

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Supplementary Table 1

Selected studies involving CCBs in elderly patients (DOC 48 kb)

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Nistala, R., Sowers, J. Synergy of antihypertensives in elderly patients with CKD. Nat Rev Nephrol 9, 13–15 (2013). https://doi.org/10.1038/nrneph.2012.264

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