Showing papers by "Luis M. Ruilope published in 2007"

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension.

Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic), Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

2007 Guidelines for the management of arterial hypertension

Abstract: For several years the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided not to produce their own guidelines on the diagnosis and treatment of hypertension but to endorse the guidelines on hypertension issued by the World Health Organization (WHO) and International Society of Hypertension (ISH)1,2 with some adaptation to reflect the situation in Europe. However, in 2003 the decision was taken to publish ESH/ESC specific guidelines3 based on the fact that, because the WHO/ISH Guidelines address countries widely varying in the extent of their health care and availability of economic resource, they contain diagnostic and therapeutic recommendations that may be not totally appropriate for European countries. In Europe care provisions may often allow a more in-depth diagnostic assessment of cardiovascular risk and organ damage of hypertensive individuals as well as a wider choice of antihypertensive treatment. The 2003 ESH/ESC Guidelines3 were well received by the clinical world and have been the most widely quoted paper in the medical literature in the last two years.4 However, since 2003 considerable additional evidence on important issues related to diagnostic and treatment approaches to hypertension has become available and therefore updating of the previous guidelines has been found advisable. In preparing the new guidelines the Committee established by the ESH and ESC has agreed to adhere to the principles informing the 2003 Guidelines, namely 1) to try to offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension, 2) to address this aim again by an extensive and critical review of the data accompanied by a series of boxes where specific recommendations are given, as well as by a concise set of practice recommendations to be published soon thereafter as already done in 2003; …

2007 ESH-ESC guidelines for the management of arterial hypertension - The task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC)

Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic) Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

Effectiveness of Blood Pressure Control Outside the Medical Setting

Abstract: We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four-hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients' BP control by physicians in the office (office BP >or=140/90 mm Hg and average daytime ambulatory BP or=135/85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects.

Effectiveness of blood pressure control outside the medical setting. Commentary

Abstract: We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four-hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients' BP control by physicians in the office (office BP ≥140/90 mm Hg and average daytime ambulatory BP <135/85 mm Hg) was 33.4%, and the proportion of isolated office control or overestimation of control (office BP <140/90 mm Hg and average daytime ambulatory BP ≥135/85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects.

Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20,000-patient database in Spain.

Abstract: ObjectiveTo evaluate ambulatory blood pressure monitoring (ABPM) parameters in a broad sample of high-risk hypertensive patients.MethodsThe Spanish Society of Hypertension is developing a nationwide project in which more than 900 physicians send ABPM registries and corresponding clinical records to

Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes.

Abstract: OBJECTIVE—One of the earliest signs of vascular change is endothelial dysfunction, which is also known to provoke albuminuria and to predict cardiovascular prognosis. The aim of this study was to analyze the effects of renin-angiotensin system (RAS) blockade on renal endothelial function. RESEARCH DESIGN AND METHODS—In a multicenter, prospective, double-blind, forced-titration, randomized study, 96 patients with type 2 diabetes, hypertension, glomerular filtration rate >80 ml/min, and normo- or microalbuminuria were treated once daily with 40/80 mg telmisartan or 5/10 mg ramipril for 9 weeks. RESULTS—The mean ± SE fall in renal plasma flow (RPF) in response to intravenous NG-monomethyl-l-arginine (l-NMMA), reflecting the magnitude of nitric oxide (NO) activity, increased with telmisartan from 71.9 ± 9.0 ml/min before therapy to 105.2 ± 9.7 ml/min at the end of treatment (P CONCLUSIONS—In patients with type 2 diabetes, telmisartan and ramipril both increased NO activity of the renal endothelium significantly, which in turn may support the preservation of cardiovascular and renal function.

Obesity, essential hypertension and renin-angiotensin system.

Abstract: Abdominal obesity is a risk factor for cardiovascular disease worldwide, and it is becoming a dramatic issue for national health systems. Overweight and obesity are highly associated with multiple comorbidities, elevated blood pressure values, dyslipidaemia, reduced insulin sensitivity and alterations of large and minor vessels. Activation of the renin-angiotensin system (RAS) in adipose tissue may represent an important link between obesity and hypertension. Angiotensin II has been shown to play a role in adipocyte growth and differentiation. Adipocytes also secrete adiponectin, enhancing insulin sensitivity and preventing atherosclerosis. Blockade of the RAS with either an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker results in a substantial increase in adiponectin levels and improved insulin sensitivity. Obesity-related hypertension needs a comprehensive approach to treatment including both weight loss and pharmacological therapies. Antihypertensive drugs prescription should be based on guidelines recommendations for management of hypertension, taking into account the growing evidences about the relationship between some antihypertensive drugs and the development of new-onset diabetes. This review discusses the role of RAS in the relationship between obesity, essential hypertension and insulin resistance.

Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study

Abstract: The CONTROLRISK study was designed to determine the cardiovascular risk profile of the hypertensive population attended at primary care and specialist setting in Spain and to investigate whether physicians stratify the risk correctly, according to the 2003 European guidelines. A total of 8920 patients were recruited from primary care (n=4485) and specialist outpatient clinic (n=4435). The age criteria was 62.6±11.1 years; 51.6% were women. No differences were observed in the severity of hypertension. More than 85% presented other cardiovascular risk factors, similarly in both groups. Target organ damage (TOD) and associated clinical conditions (ACC) were more frequent in specialist setting (57.6 vs 34.3% and 39 vs 28.7%, both P<0.0001). The most common risk factor was age. The most frequently reported TOD was left ventricular hypertrophy (42.3 and 22.1%; P<0.0001). Ischemic heart disease was the most common ACC (21.5 vs 13.1%; P<0.0001). The risk profile was significantly higher in specialist population (75.1 vs 60.3% of patients belonged to high- or very high-risk groups). Specialists and primary care physicians stratified only 54.6 and 48% of their patients correctly, respectively (P<0.05). Both, specialists and general practitioners (GPs) strongly underestimated the risk. Very high-risk patients were adequately assessed only in 44.9% of cases by specialists and in 25.3% by GPs (P<0.001). More than half of the hypertensive patients attended by GPs in Spain belong to the high- or very high-risk groups. GPs and specialists tend to underestimate the cardiovascular risk in daily clinical practice, mainly in very high-risk patients.

Prediction of cardiovascular outcome by estimated glomerular filtration rate and estimated creatinine clearance in the high-risk hypertension population of the VALUE trial.

Abstract: BackgroundReduced renal function is predictive of poor cardiovascular outcomes but the predictive value of different measures of renal function is uncertain.MethodsWe compared the value of estimated creatinine clearance, using the Cockcroft–Gault formula, with that of estimated glomerular filtration

Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry.

Abstract: ObjectivesTo assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h.Patients and methodsPatients undergoing 48-h ABPM within the National

Cardiovascular risk reduction by reversing endothelial dysfunction: ARBs, ACE inhibitors, or both? Expectations from the ONTARGET Trial Programme.

Abstract: Endothelial dysfunction is the initial pathophysiological step in a progression of vascular damage that leads to overt cardiovascular and chronic kidney disease. Angiotensin II, the primary agent of the renin-angiotensin system (RAS), has a central role in endothelial dysfunction. Therefore, RAS blockade with an angiotensin receptor blocker (ARB) and/or angiotensin-converting enzyme (ACE) inhibitor provides a rational approach to reverse endothelial dysfunction, reduce microalbuminuria, and, thus, improves cardiovascular and renal prognosis. ARBs and ACE inhibitors act at different points in the RAS pathway and recent evidence suggests that there are differences regarding their effects on endothelial dysfunction. In addition to blood pressure lowering, studies have shown that ARBs reduce target-organ damage, including improvements in endothelial dysfunction, arterial stiffness, the progression of renal dysfunction in patients with type 2 diabetes, proteinuria, and left ventricular hypertrophy. The ONgoing Telmisartan Alone in combination with Ramipril Global Endpoint Trial (ONTARGET) Programme is expected to provide the ultimate evidence of whether improved endothelial function translates into reduced cardiovascular and renal events in high-risk patients, and to assess possible differential outcomes with telmisartan, the ACE inhibitor ramipril, or a combination of both (dual RAS blockade). Completion of ONTARGET is expected in 2008.

Monitorización ambulatoria de la presión arterial (MAPA): características clínicas de 31.530 pacientes

Abstract: Fundamento y objetivo La monitorizacion ambulatoria de la presion arterial (MAPA) constituye una herramienta util en el diagnostico y seguimiento de los pacientes hipertensos. El presente estudio analiza las caracteristicas clinicas de una serie de 31.530 pacientes sometidos a una MAPA dentro del Registro Nacional. Pacientes y metodo Un total de 767 investigadores incluyeron en el estudio a pacientes con sospecha o diagnostico de hipertension en los que se indico la practica de una MAPA de 24 h con un monitor validado. Se registraron las medias de presion durante los periodos diurno, nocturno y de 24 h y se definieron los perfiles circadianos en funcion del descenso nocturno de presion sistolica: dipper extremo (> 20%), dipper (10-20%), no dipper ( Resultados Los valores de presion arterial de 24 h, diurna y nocturna fueron inferiores a los obtenidos en la consulta. Un 20% de los pacientes presentaba cifras elevadas en la consulta y normales en la MAPA (hipertension arterial [HTA] de «bata blanca» o seudorresistencia), y un 9%, cifras altas en la MAPA y normales en la consulta (HTA enmascarada). Los perfiles no dipper o riser estaban presentes en mas de la mitad de los pacientes (el 40,2 y el 13,4%, respectivamente) y se asociaban a grupos de mayor riesgo cardiovascular. Conclusiones Casi una tercera parte de los pacientes presenta cifras de presion arterial no concordantes entre la medida clinica y la MAPA. Mas de la mitad, especialmente los hipertensos de mayor riesgo, presentan un perfil circadiano en el que no se produce un adecuado descenso nocturno de presion.

The need for combination antihypertensive therapy to reach target blood pressures: what has been learned from clinical practice and morbidity-mortality trials?

Abstract: Summary Pharmacological treatment of hypertension represents a cost-effective way for preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment blood pressure (BP) should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Most of the time such targets cannot be reached using monotherapies. This is especially true in patients who exhibit a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases BP control. Such preparations are not only efficacious, but also well tolerated, and some fixed low-dose combinations have a tolerability profile similar to placebo. This is for instance the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has recently been shown in controlled interventional trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving macrovascular stiffness. Fixed-dose combinations are becoming more and more popular and are even proposed by current hypertension guidelines as a first-line option to treat hypertensive patients.

Amlodipine and valsartan: calcium channel blockers/angiotensin II receptor blockers combination for hypertension

Abstract: Despite the availability of numerous antihypertensive agents, many patients with hypertension fail to achieve the blood pressure goals set out in current guidelines. These patients remain at a high risk of cardiovascular morbidity and mortality and require effective treatment options to reduce that risk. Current guidelines recognize that many patients require multiple antihypertensive agents to achieve blood pressure goals. Numerous combination therapies are available, although there is currently no available fixed-dose alternative that combines the benefits of angiotensin receptor blockers and calcium channel blockers. This article explores the rationale for using multiple-mechanism therapy with the angiotensin receptor blocker valsartan and the calcium channel blocker amlodipine and discusses the clinical data supporting this novel approach to the treatment of hypertension.

Uric acid and other renal function parameters in patients with stable angina pectoris participating in the ACTION trial: impact of nifedipine GITS (gastro-intestinal therapeutic system) and relation to outcome.

Abstract: BACKGROUND: Little data is available concerning the prognostic implications of renal function abnormalities, their evolution over time and the effects of nifedipine on such abnormalities in patients with stable angina pectoris. METHODS: The previously published ACTION trial compared long-acting nifedipine GITS 60 mg once daily to placebo among 7665 patients. Standard laboratory tests including creatinine and uric acid were assessed at baseline, after 6 months, 2 and 4 years, and at the end of follow-up. We assessed the impact of nifedipine on markers of renal dysfunction and determined whether evidence of renal failure alters the impact of nifedipine on the clinical outcome of patients with stable angina. RESULTS: Uric acid was not while creatinine level and estimated creatinine clearance were potent conditionally independent predictors of total mortality and of cardiovascular clinical events. Relative to placebo, nifedipine reduced 6-month uric acid levels by 3% (P < 0.001) of the baseline value. This difference was maintained during long-term follow-up, was present both in normotensives and in hypertensives, and was not explained by differences in diuretic therapy or allopurinol use. Nifedipine had no effect on the occurrence of clinical renal failure. Relative to placebo, the effects of nifedipine on cardiovascular death or myocardial infarction [hazard ratio (HR) = 1.01, 95% confidence interval (CI) 0.88-1.17], any stroke or transient ischaemic attack (HR = 0.73, 95% CI 0.60-0.88), new overt heart failure (HR = 0.72, 95% CI 0.55-0.95), and the need for any coronary procedure (HR = 0.81, 95% CI 0.75-0.88) were consistent across strata of markers of renal dysfunction. CONCLUSIONS: We conclude that, in patients with stable angina, nifedipine reduces uric acid levels and does not affect other markers of renal dysfunction. Renal dysfunction does not alter the effects of nifedipine on clinical outcome.

The kidney and cardiovascular risk – Implications for management: A consensus statement from the European Society of Hypertension

Abstract: Cardiovascular and renal diseases share many of the same risk factors. In fact, renal failure is usually accompanied by an increased global cardiovascular risk. Thus, preservation of kidney function might simultaneously protect the heart and the brain and, conversely, addressing cardiovascular risk factors might safeguard the kidney. This review considers the evidence supporting this approach, focusing on the protective effect of blood-pressure lowering and the ancillary actions of antihypertensive agents on renal protection. We review recent evidence on renal protection in individuals with and without diabetes, and the importance of offering a high standard of care also to those with the metabolic syndrome or prediabetes in order to prevent initial forms of renal, and as a consequence, cardiovascular damage. Intervention may be appropriate even in individuals with high-normal blood pressure, if they already have early renal and/or cardiovascular risk markers. As a consequence of these insights, thresholds for starting antihypertensive therapy are gradually falling, whereas awareness of the need for an early intervention in patients at high risk of developing renal damage and simultaneously cardiovascular disease is growing.

Should hypertension guidelines be changed for hypertensive patients with the metabolic syndrome

Abstract: The authors analyzed the impact of present guidelines for hypertension management on cardiovascular (CV) risk factors in hypertensive patients with and without the metabolic syndrome (MS). Results in 549 nondiabetic hypertensive patients with a mean follow-up of 3.8±1.2 years on usual recommended care were reviewed. At baseline, 231 (42.1%) patients had MS and, per the definition, showed significantly higher values of traditional CV risk factors than non-MS patients. At the end of follow-up, blood pressure levels were similar in both groups; the lipid profile tended to improve in MS patients. Eighteen MS patients (7.8%) and 7 non-MS patients (2.2%) developed diabetes (P<.001). Prevalence of microalbuminuria was reduced in both groups, but it remained significantly higher in MS patients. Usual care of hypertensive patients achieved similar blood pressure and low-density lipoprotein cholesterol goals, both in MS and non-MS patients. Global CV risk, however, remained higher in MS patients, as suggested by a 3-fold higher incidence of new-onset diabetes (absolute increase of 5.6%) and a 2-fold increase in microalbuminuria.

Estratificación y grado de control del riesgo cardiovascular en la población hipertensa española. Resultados del estudio DICOPRESS

Abstract: Fundamento y objetivo La hipertension arterial, junto con otros factores de riesgo, representa el principal determinante de enfermedades cardiovasculares. El proposito del presente estudio ha sido evaluar el riesgo cardiovascular en poblacion hipertensa espanola segun los criterios de la guia elaborada en 2003 por la Sociedad Europea de Hipertension y la Sociedad Europea de Cardiologia (ESH/ESC-2003), asi como describir el grado de control de los principales factores de riesgo cardiovasculares (FRCV). Pacientes y metodo Se ha realizado un estudio observacional y transversal en el que se incluyo a 22.639 pacientes con diagnostico de hipertension arterial esencial, procedentes de consultas de atencion primaria y unidades de hipertension de todo el territorio nacional. Resultados El FRCV asociado con mayor prevalencia fue la dislipemia (52,1%), seguido de diabetes (36,6%) y tabaquismo (22,3%). La estratificacion del riesgo cardiovascular segun la guia ESH/ESC-2003 mostro que mas del 70% de los pacientes presentaba un riesgo alto (36,9%) o muy alto (35,8%), mientras que en solo un 7,6% el riesgo era bajo. El factor de riesgo peor controlado entre la poblacion hipertensa analizada fue la presion arterial (un 80,6% de los pacientes). Otro factor de riesgo mal controlado en una parte importante de la poblacion analizada fue el colesterol total (66,4%). El predictor mas importante del mal control de la presion arterial fue la diabetes, con una odds ratio de 5,25 (intervalo de confianza del 99%, 4,57-6,06). Conclusiones La coexistencia de distintos FRCV, asi como la presencia de lesiones en organo diana y trastornos clinicos asociados en la poblacion hipertensa espanola, incrementa el riesgo vascular de la poblacion hipertensa, dificulta el control e indica la conveniencia de utilizar la guia ESH/ESC-2003 en la estimacion del riesgo cardiovascular.

Antihypertensive effectiveness of lercanidipine administered using an electronic pillbox compared with usual care in a cohort of mild-to-moderately hypertensive patients: the ELECTRA study

Abstract: Objective: It has been suggested that poor blood pressure (BP) control in the community is related to poor treatment tolerability and compliance. In the ELECTRA study we assessed whether the use of an electronic pillbox device (medical event monitoring system [MEMS]) could improve antihypertensive effectiveness of lercanidipine in a large group of hypertensive patients treated for 12 weeks. Methods: A total of 1523 outpatients with mild-to-moderate essential hypertension participated in this multicenter, randomized, open-label study. All patients received lercanidipine 10 mg once daily for 12 weeks. They were randomly allocated in a 1:2 design to use MEMS (n = 485) or usual care (actively monitored pill counts; n = 1038). If BP control was not achieved, additional therapy was allowed. Compliance was considered to be good if over 80% of tablets were taken by the patient. Results: Good compliance was observed in 92% of the MEMS group versus 91% of the usual-care group (p = not significant). At the study end...

The Meaning of Cardiometabolic Risk in Hypertensive Patients

Abstract: Cardiometabolic risk is a condition in which the possibilities of developing atherosclerotic cardiovascular (CV) disease and diabetes mellitus are significantly enhanced as a consequence of the presence of insulin resistance and atherogenic dyslipidemia, the latter being characterized by the presence of low high-density lipoprotein (HDL)-cholesterol and high triglyceride levels. Cardiometabolic risk is diagnosed by the identification of an enhanced waist circumference (above 102cm in males and 88cm in females) accompanied by the alterations in lipid profile quoted above (HDLcholesterol below 40mg/dl in males and 50mg/dl in females, and serum triglycerides above 150mg/dl).

Clinical trials in nephrology: success or failure.

Abstract: Purpose of review A large amount of clinical and epidemiologic evidence has been gathered supporting the importance of blood pressure control in reducing chronic kidney disease progression. Suppression of the rennin–angiotensin–aldosterone system should also be considered in any patient with chronic kidney disease, in particular if albuminuria is present. Recent findings Analysis of renal outcome by estimating glomerular filtration rate in trials primarily devoted to cardiovascular protection in hypertensive patients, in particular the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial trial, has come to question the effectiveness of suppressing the rennin–angiotensin–aldosterone system in controlling blood pressure and thus protecting the kidney in hypertensive patients. This subject is particularly interesting because the existence of an increased cardiovascular risk associated with renal function decline has been demonstrated in many different clinical conditions including arterial hypertension. The increase in global cardiovascular risk accompanying chronic kidney disease would necessitate the use of drugs suppressing the rennin–angiotensin–aldosterone system for cardiovascular protection irrespective of the influence on renal outcome. Summary This review includes the most recent data evaluating renal endpoints in clinical trials primarily devoted to renal function as well as those dedicated to arterial hypertension and its cardiovascular consequences.

Are differences in calcium antagonists relevant across all stages of nephropathy or only proteinuric nephropathy

Abstract: Purpose of review The main effects of classic calcium antagonists are mediated by the inhibition of L-type calcium channels broadly distributed within the renal vascular bed. Calcium antagonists act predominantly on the afferent arterioles, and dihydropyridines can favour the increase in glomerular hypertension and progression of kidney diseases, in particular when systemic blood pressure remains uncontrolled. Recent findings Calcium antagonists have been widely used in clinical practice because of their antihypertensive capacity. The prevention of renal damage is a very important aim of antihypertensive therapy. This is particularly so taking into account the high prevalence of chronic kidney disease in the general population. Non-dihydropyridines such as verapamil have been shown to possess an antiproteinuric effect that could be particularly relevant. Summary Recent data from clinical trials have confirmed that, in hypertensive patients with preserved renal function or with chronic kidney disease, calcium antagonists are effective antihypertensive drugs to be considered alone or in combination with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In those patients presenting with proteinuric kidney disease, non-dihydropyridines could reduce proteinuria to a greater degree than dihydropyridines.