Abstract
Antihypertensive drugs may have an important effect on glomerular haemodynamics. In chronic nephropathy patients, we compared the effect on glomerular haemodynamics of two second-generation dihydropyridinic agents, nitrendipine and amlodipine, with a first generation dihydropyridinic agent and an ACE-inhibitor, enalapril. In all, 32 patients (pts), divided into four groups, received the different drugs: ENA (enalapril, eight pts), NIF (nifedipine, eight pts), NIT (nitrendipine, eight pts) AML (amlodipine, eight pts). The study assessed the effect on glomerular haemodynamics of a single administration of the test drug in baseline conditions and in glomerular hyperfiltration experimentally induced by amino-acid infusion. The glomerular filtration rate (GFR, measured by inulin clearance), effective renal plasma flow (ERPF, measured by p-aminohippurate clearance), renal vascular resistances (RVR) and filtration fraction (FF) were assessed. Administration of AML and NIT test dose reduced FF, as did ENA, but not NIF, in both baseline (AML: P=0.005; NIT: P=0.02; ENA: P=0.007) and glomerular hyperfiltration conditions (AML: P=0.0003; NIT: P=0.03; ENA: P=0.00006). In baseline conditions, only ENA resulted in a significant drop in the GFR (P=0.008), while NIF, NIT and AML induced a significant increase (P=0.003, 0.03, 0.0001, respectively). However, in hyperfiltration conditions, NIT (0.08) and AML (0.00003) caused a decrease in the GFR, as did ENA (0.0003) but not NIF. In all the experimental conditions, a RVR reduction and an ERPF increase were observed. Single dose of NIT and AML were effective in attenuating the effect of amino-acid infusion on glomerular filtration, similar to ENA; this effect of NIT and AML on the glomerular filtration rate is not observed under basal conditions.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Raij L, Chiou XC, Owens R, Wrigley B . Therapeutic implications of hypertension induced glomerular injury. Am J Med 1985; 79: 37–41.
Anderson S, Meyer TW, Rennke HG, Brenner BM . Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest 1985; 76: 612–619.
Meyer TW, Anderson S, Rennke HG, Brenner BM . Reversing glomerular hypertension stabilizes established glomerular injury. Kidney Int 1987; 31: 751–759.
Anderson S . Antihypertensive therapy and the progression of renal disease. J Hypertens 1989; 7 (Suppl): S39–S42.
Bedogna V et al. Effects of ACE inhibition in normo-tensive patients with chronic glomerular disease and normal renal function. Kidney Int 1990; 38: 101–107.
Bauer JH, Reams GP, Lal SM . Renal protective effect of strict blood pressure control with enalapril therapy. Arch Intern Med 1987; 147: 1397–1400.
Simons JL et al. Modulation of glomerular hypertension defines susceptibility to progressive glomerular injury. Kidney Int 1994; 46: 396–404.
Vos PF, Boer P, Braam B, Koomans HA . Efficacy of intrarenal ACE-inhibition estimated from the renal response to angiotensin I and II in humans. Kidney Int 1995; 47: 274–281.
Juncos LI et al. Abnormal renal vasodilation to an amino acid infusion in congestive heart failure: normalization by enalapril. Am J Kidney Dis 1999; 33: 43–51.
Fridman K, Wysocki M, Friberg P, Andersson OK . Candesartan cilexetil and renal hemodynamics in hypertensive patients. Am J Hypertens 2000; 13: 1045–1048.
Buter H, Navis G, de Zeeuw D, de Jong PE . Renal hemodynamic effects of candesartan in normal and impaired renal function in humans. Kidney Int 1997; 63 (Suppl): S185–S187.
Heller J, Horacek V . The effect of two different calcium antagonists on the glomerular haemodynamics in the dog. Pflugers Arch 1990; 415: 751–755.
Hayashi K et al. Disparate effects of calcium antagonists on renal microcirculation. Hypertens Res 1996; 19: 31–36.
Ruggenenti P, Perna A, Benini R, Remuzzi G . Effects of dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibition, and blood pressure control on chronic, nondiabetic nephropathies. Gruppo Italiano di Studi epidemiologici in Nefrologia (GISEN). J Am Soc Nephrol 1998; 9: 2096–2101.
Kvam FI, Ofstad J, Iversen BM . Effects of antihypertensive drugs on autoregulation of RBF and glomerular capillary pressure in SHR. Am J Physiol 1998; 275 (4 Part 2): F576–F584.
Scaglione R et al. Antihypertensive efficacy and effects of nitrendipine on cardiac and renal hemodynamics in mild to moderate hypertensive patients: randomized controlled trial versus hydrochlorothiazide. Cardiovasc Drugs Ther 1992; 6: 141–146.
Kloke HJ et al. Effects of nitrendipine and cilazapril on renal hemodynamics and albuminuria in hypertensive patients with chronic renal failure. J Cardiovasc Pharmacol 1990; 16: 924–930.
Grossman E et al. Systemic and regional hemodynamic and humoral effects of nitrendipine in essential hypertension. Circulation 1988; 78: 1394–1400.
Schmitz A . Acute renal effects of oral felodipine in normal man. Eur J Clin Pharmacol 1987; 32: 17–22.
Holdaas H et al. Renal effects of losartan and amlodipine in hypertensive patients with non-diabetic nephropathy. Nephrol Dial Transplant 1998; 13: 3096–3102.
August P, Lenz T, Laragh JH . Comparative renal hemodynamic effects of lisinopril, verapamil, and amlodipine in patients with chronic renal failure. Am J Hypertens 1993; 6: 148S–154S.
Licata G et al. Effects of amlodipine on renal haemodynamics in mild to moderate hypertensive patients. A randomized controlled study versus placebo. Eur J Clin Pharmacol 1993; 45: 307–311.
Loutzenhiser RD, Epstein M, Fischetti F, Horton C . Effects of amlodipine on renal hemodynamics. Am J Cardiol 1989; 64: 122I–128I.
Reams GP, Lau A, Hamory A, Bauer JH . Amlodipine therapy corrects renal abnormalities encountered in the hypertensive state. Am J Kidney Dis 1987; 10: 446–451.
Viberti G et al. Effect of protein-restricted diets on renal response to a meat meal in humans. Am J Physiol (Renal, Fluid Electrol Physiol) 1987; 22: F388–F393.
Bergstrom J, Ahlberg M, Alvestrand A . Influence of protein intake on renal hemodynamics and plasma hormone concentrations in normal subjects. Acta Med Scand 1985; 217: 189–196.
Jones MG, Lee K, Swaminathan R . The effect of dietary protein on glomerular filtration rate in normal subjects. Clin Nephrol 1987; 27: 71–75.
Paller MS, Hostetter TH . Dietary protein increases plasma renin and reduces pressor reactivity to angiotensin II. Am J Physiol (Renal, Fluid Electrol Physiol) 1986; 20: F34–F39.
Liedtke RR, Duarte CG . Laboratory protocols and methods for the measurement of glomerular filtration rate and renal plasma flow. In: Duarte CG (ed). Renal Function Tests: Clinical Laboratory Procedures and Diagnosis. Little Brown Company: Boston, 1980, pp 49–63.
Walser M, Davidson DG, Orloff J . The renal clearance of alkali-stable inulin. J Clin Invest 1955; 34: 1520–1523.
Raemsch KD, Sommer J . Pharmacokinetics and metabolism of nifedipine. Hypertension 1983; 5 (Suppl II): II-18–II-24.
Dylewicz P et al. Bioavailability and elimination of nitrendipine in liver disease. Eur J Clin Pharmacol 1987; 32: 563–568.
Reid JL, Meredith PA, Donnelly R, Elliott HL . Pharmacokinetics of calcium antagonists. J Cardiovasc Pharmacol 1988; 12 (Suppl 7): S22–S26.
Carmines PK, Perry MD, Hazelrig JB, Navar LG . Effects of preglomerular and postglomerular vascular resistance alterations on filtration fraction. Kidney Int 1987; 20 (Suppl): S229–S232.
Hall JE et al. Control of glomerular filtration rate by circulating angiotensin II. Am J Physiol 1981; 241: R190–R197.
Pelayo JC, Quan AH, Shanley PF . Angiotensin II con-trol of the renal microcirculation in rats with reduced renal mass. Am J Physiol 1990; 258: F414–F422.
Steinhausen M et al. Angiotensin II control of the renal microcirculation: effect of blockade by saralasin. Kidney Int 1986; 30: 56–61.
Navar LG, Rosivall L, Carmines PK, Oparil S . Effects of locally formed angiotensin II on renal hemodynamics. Fed Proc 1986; 45: 1448–1453.
Epstein M, Hayashi K, Loutzenhiser R . Nifedipine prevents pressure-induced afferent arteriolar vasoconstriction in isolated perfused hydronephrotic kidneys from hypertensive rats. Kidney Int 1989; 35: 427.
Loutzenhiser RD, Epstein M . Renal hemodynamic effects of calcium antagonists. J Cardiovasc Pharmacol 1988; 12 (Suppl 6): S48–S52.
Fleming JT, Parekh N, Steinhausen M . Calcium antagonists preferentially dilate preglomerular vessels of hydronephrotic kidney. Am J Physiol 1987; 253: F1157–F1163.
Ozawa Y et al. Renal afferent and efferent arteriolar dilation by nilvadipine: studies in the isolated perfused hydronephrotic kidney. J Cardiovasc Pharmacol 1999; 33: 243–247.
ter Wee PM, Donker AJ . Pharmacologic manipulation of glomerular function. Kidney Int 1994; 45: 417–424.
Dworkin LD, Ichikawa I, Brenner BM . Hormonal modulation of glomerular function. Am J Physiol 1983; 244: F95–F104.
Acknowledgements
This study was partly supported by Grants (40%: 92.02039, 60%: 97.66633) from the Ministry of University and Scientific and Technological Research, Rome, Italy. Part of this work was presented at the European Dialysis Transplant Association meeting, Geneva, Switzerland, 21–24 September, 1997. We thank Ms MVC Pragnell, BA, for her help in revising the English text.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morrone, L., Ramunni, A., Fassianos, E. et al. Nitrendipine and amlodipine mimic the acute effects of enalapril on renal haemodynamics and reduce glomerular hyperfiltration in patients with chronic kidney disease. J Hum Hypertens 17, 487–493 (2003). https://doi.org/10.1038/sj.jhh.1001579
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1001579