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Can Calcium Channel Blockers Preserve Renal Function Better Than Diuretics During Antihypertensive Treatment?
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We read with great interest the recent article by de Leeuw and colleagues.1 Their Intervention as a Goal in Hypertension Treatment (INSIGHT) trial is the landmark study to compare cardiovascular outcomes of 2 classes of antihypertensive agents: nifedipine and the hydrochlorothiazide–amiloride hydrochloride combination. In the post hoc analysis, they concluded that renal function was better preserved with therapy with a calcium channel blocker than with diuretics.1 However, the reduction in glomerular filtration rate (GFR) with diuretic treatment is functional and therefore may be favorable for renoprotection, as recognized by inhibitors of the renin-angiotensin system.
Diuretics suppress tubular sodium reabsorption, making urinary sodium excretion (UNaV) greater than intake. As far as blood pressure, glomerular capillary pressure, GFR, and tubular sodium load remain at baseline, sodium balance continues to be negative, resulting in a fall in blood pressure. As blood pressure is lowered, glomerular capillary pressure is also lowered, leading to . . . [Full Text of this Article]
AUTHOR INFORMATION
Michio Fukuda, MD;
Genjiro Kimura, MD
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Can Calcium Channel Blockers Preserve Renal Function Better Than Diuretics During Antihypertensive Treatment?—Reply
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Arch Intern Med. 2005;165(11):1312-1313.
EXTRACT
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Arch Intern Med. 2004;164(22):2459-2464.
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