Slow-release isradipine significantly reduced urinary albumin excretion (P<0.05) and achieved blood pressure normalization in 100% of low-renin versus 57% of high/medium-renin patients.
RCT (n=26)
Randomly assigned
Does slow-release isradipine reduce blood pressure and improve renal parameters in patients with mild to moderate essential hypertension, and does efficacy vary by baseline plasma renin activity?
Isradipine effectively reduces blood pressure and urinary albumin excretion in essential hypertension, with a more pronounced antihypertensive effect in patients with low baseline plasma renin activity.
p-value: p=<0.05
Calcium antagonists are known to exert various effects on the kidney that might modulate their antihypertensive potential. This study evaluated the renal effects, along with the efficacy, of isradipine in two subgroups of patients with mild to moderate essential hypertension (EH), defined according to plasma renin activity (PRA). Twenty-six patients were randomly assigned to receive 12-week treatment with slow-release isradipine (2.5-5 mg) or placebo. Assessment of PRA related to concurrent 24-hour sodium excretion was used to define patients with high/medium (n=16) and low renin profile (n=10). Urinary albumin excretion (UAE), serum creatinine and glomerular filtration rate (GFR, as endogenous creatinine clearance) were measured. Blood pressure (BP) decrease with isradipine was greater in the low PRA group as compared with the high/medium PRA group (P<0.05), and normalization of BP was achieved in all low-renin patients compared with 57% in the high/medium PRA group. BP reduction in the placebo group was statistically not significant. Isradipine, but not placebo, induced significant reduction in UAE (P<0.05); the decrease was similar in both PRA groups. Treatment did not cause any significant changes in GFR, PRA, urinary sodium or creatinine excretion, or serum aldosterone or creatinine concentrations. The decrease of BP in the whole isradipine-treated group was inversely correlated with pretreatment serum creatinine as well as with basal urinary creatinine excretion. In conclusion, the antihypertensive effect of isradipine was more pronounced in low-renin EH patients, despite similar effects on renal function and UAE in both PRA groups.
Allikmets et al. (Sat,) conducted a rct in Mild to moderate essential hypertension (n=26). Slow-release isradipine vs. Placebo was evaluated on Blood pressure (BP) decrease and normalization (p=<0.05). Slow-release isradipine significantly reduced urinary albumin excretion (P<0.05) and achieved blood pressure normalization in 100% of low-renin versus 57% of high/medium-renin patients.