Calcium channel blocker therapy and retarding the progression of chronic renal disease

Summary: Calcium channel blockers are a heterogeneous group of agents that interfere with transmembrane calcium influx, and are effective and widely used as antihypertensive agents. At the level of the renal microcirculation they reverse the afferent arteriolar vasoconstriction induced by diverse agonists, and therefore should theoretically counteract the maladaptive haemodynamic changes that initiate and modulate the progression of kidney disease. In addition to achieving good control of systemic and thus intraglomerular blood pressures, calcium channel blockers have specific renoprotective effects. Their use has been associated, in experimental animals and in man, with retarding the progression of both chronic renal disease and diabetic renal disease. Combined therapy with an ACE inhibitor appears to offer additional protection to the kidney and allows for the use of lower doses of both agents and thus a lower side‐effect profile. From a practical point of view, in patients with chronic renal disease it is often difficult to achieve control of blood pressure with one antihypertensive medication alone, and therapy with two agents offering renoprotective potential is a preferred strategy. In view of the preferential dilatation of afferent arterioles by calcium channel blockers, it is important to achieve tight control of systemic blood pressure and to use long‐acting agents to protect the glomeruli from the deleterious effects of raised intraglomerular pressures. Calcium channel blockers should be used in patients with potentially progressive renal disease in an endeavour to help slow this progression.