Summary
The renal effects of oral maintenance doses of nicardipine 60–120 mg/day have been studied in 18 hypertensive patients with Type 2 (non-insulin-dependent) diabetes mellitus: 6 with normoalbuminuria (urinary albumin excretion rate, AER <20 μg · min−1, Group A); 6 with incipient nephropathy, (AER 20–200 μg · min−1, Group B); and 6 with overt nephropathy (AER >200 μg · min−1, Group C). Treatment for 4 weeks significantly lowered the systolic and diastolic blood pressures and reduced total renal vascular resistance in all three groups. Nicardipine increased renal blood flow significantly in Group C and slightly in Group B, and had no effect in Group A. Glomerular filtration rate remained unchanged in all three groups. It significantly reduced AER and the fractional clearance of albumin in Group B, whereas AER in Groups A and C was not altered. Plasma renin activity, aldosterone concentration, osmotic pressure, serum total protein and albumin concentrations and haemoglobin A1c level were similar in the control and nicardipine phases in all three groups. The results suggest that nicardipine may preserve renal function whilst having a concomitant hypotensive action in hypertensive Type 2 diabetic patients with normoalbuminuria and incipient nephropathy, and that the drug may improve renal blood flow in patients with overt nephropathy. The effect of the drug on urinary albumin excretion may deserve further investigation.
Similar content being viewed by others
References
Pell S, D'Alonzo CA (1967) Some aspects of hypertension in diabetes mellitus. JAMA 202: 104–110
Baba T, Murabayashi S, Aoyagi K, Sasaki K, Imamura K, Kudo M, Takebe K (1985) Prevalence of hypertension in diabetes mellitus: Its relation to diabetic nephropathy. Tohoku J Exp Med 145: 167–173
Mogensen CE (1982) Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J 285: 685–688
Parving H-H, Andersen AR, Smidt UM, Svendsen PAa (1983) Early and appressive antihypertensive treatment reduces rate of decline in kidney function indiabetic nephropathy. Lancet I: 1175–1178
Pedrinelli R, Fouad FM, Tarazi RC, Bravo EL, Textor SC (1986) Nitrendipine: a calcium-entry blocker: renal and humoral effects in human arterial hypertension. Arch Intern Med 146: 62–65
Sunderrajan S, Reams G, Bauer JH (1987) Long-term renal effects of diltiazem in essential hypertension. Am Heart J 114: 383–388
van Schaik BAM, van Nistelrooy AEJ, Geyskes GG (1984) Antihypertensive and renal effects of nicardipine. Br J Clin Pharmacol 18: 57
Reams G, Hamory A, Lau A, Bauer JH (1988) Effect of nifedipine on renal function in patients with essential hypertension. Hypertension 11: 452–456
Hulthèn UL, Katzman PL (1988) Renal effects of acute and long-term treatment with felodipine in essential hypertension. J Hypertension 6: 231–237
Baba T, Murabayashi S, Takebe K (1989) Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive Type 2 (non-insulin-dependent) diabetic patients with microalbuminuria: a randomised controlled trial. Diabetologia 32: 40–44
Baba T, Ishizaki T, Ido Y, Aoyagi K, Murabayashi S, Takebe K (1986) Renal effects of nicardipine, a calcium entry blocker, in hypertensive Type II diabetic patients with nephropathy. Diabetes 35: 1206–1214
Baba T, Boku A, Ishizaki T, Sone K, Takebe K (1986) Renal effects of nicardipine in patients with mild-to-moderate essential hypertension. Am Heart J 111: 552–557
Mogensen CE (1987) Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 31: 673–689
Resenstock J, Raskin P (1986) Early diabetic nephropathy: assessment and potential therapeutic intervention. Diabetes Care 9: 529–545
Taylor SH, Frais MA, Lee P, Verma SP, Jackson N, Silke B (1985) Anti-hypertensive dose-response effects of nicardipine in stable essential hypertension. Br J Clin Pharmacol 20: 135S-138S
Gomez DM (1951) Evaluation of renal resistances with special reference to changes in essential hypertension. J Clin Invest 30: 1143–1155
Willassen Y, Ofsted J (1983) Intrarenal pressure and sodium excretion in hypertension of chronic glomerulonephritis in humans. Hypertension 5: 375–384
Haber E, Koerner T, Page LB, Klinman B, Purnode A (1969) Application of a radioimmunoassay for angiotensin I to the physiologic measurements of plasma renin activity in normal human subjects. J Clin Endocrinol Metab 29: 1349–1355
Ogihara T, Iinuma K, Nishi K, Arakawa Y, Takagi A, Kurata K, Miyai K, Kumahara Y (1977) A non-chromatographic non-extraction radioimmunoassay for serum aldosterone. J Clin Endocrinol Metab 45: 726–731
Miles DW, Mogensen CE, Gundersen HJG (1979) Radioimmunoassay for urinary albumin using a single antibody. Scand J Clin Lab Invest 26: 5–11
Davis JE, McDonald JM, Jarrett L (1978) A high-performance liquid chromatography method for hemoglobin A1c. Diabetes 44: 1066–1069
Mercier DE, Feld RD, Witte DL (1978) Comparison of dewpoint and freezing point osmometry. Am J Med Tech 44: 1066–1069
Taylor SH, Silke B, Ahuja RC, Okoli R (1982) Influence of nicardipine on blood pressure at rest and on the pressor responses to cold, isometric exertion, and dynamic exercise in hypertensive patients. J Cardiovasc Pharmacol 4: 803–807
Erne P, Bolli P, Bertel O, Hulthen UL, Kiowski W, Muller FB, Buhler F (1983) Factors influencing the hypotensive effects of calcium antagonists. Hypertension 5 [Suppl II]: II-97-10
Asplund J (1985) Nicardipine hydrochloride in essential hypertension: a controlled study. Br J Clin Pharmacol 20 [Suppl]: 120S-124S
McLeay RAB, Stallard TJ, Watson RDS, Littler WA (1983) The effect of nifedipine on arterial pressure and reflex cardiac control. Circulation 67: 1084–1090
Kiowski W, Bertel O, Erne P, Bolli P, Hulthén UL, Ritz R, Buhler FR (1983) Hemodynamic and reflex responses to acute and chronic antihypertensive therapy with the calcium entry blocker nifedipine. Hypertension 5 [Suppl I]: I-70–74
Young MjA, Watson RDS, Littler WA (1984) Baroreflex setting and sensitivity after acute and chronic nicardipine therapy. Clin Sci 66: 233–235
Kahn JK, Zola B, Juni JE, Vinik AI (1986) Decreased exercise heart rate and blood pressure response in diabetic subjects with cardiac autonomic neuropathy. Diabetes Care 9: 389–394
Dyrberg TM, Benn J, Sandahl CJ, Hilsted J, Nerup J (1981) Prevalence of diabetic autonomic neuropathy measured by simple bedside tests. Diabetologia 20: 190–194
Sundkvist G, Lilja B (1985) Autonomic neuropathy in diabetes mellitus: a follow-up study. Diabetes Care 8: 129–133
Ewing DJ, Clarke BF (1986) Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 9: 648–665
Loutzenhiser R, Epstein M (1985) Effects of calcium antagonists on renal hemodynamics. Am J Physiol 249: F619-F629
Christensen C, Mogensen CE (1985) Effect of antihypertensive treatment on progression of incipient diabetic nephropathy. Hypertension 7 [Suppl]: II-109–II-113
Parving H-H, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Sevendsen PA (1987) Effect of antihypertensive treatment on kidney function in diabetic nephropathy. Br Med J 294: 1443–1447
Marre M, Leblanc H, Suarez L, Guyenne T-T, Mènard J, Passa P (1987) Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. Br Med J 294: 1448–1452
Dunn BR, Zatz R, Rennke HG, Meyer TW, Anderson S, Brenner BM (1986) Prevention of glomerular capillary hypertension in experimental diabetes mellitus obviates functional and structural glomerular injury. J Hypertens 4 [Suppl 5]: S251-S254
Hommel E, Parving H-H, Mathiesen E, Edsberg B, Neilsen MD, Giese J (1986) Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. Br Med J 293: 467–470
Myers BD, Deen WM, Brenner BM (1975) Effect of norepine-phrine and angiotensin II on the determinants of glomerular ultrafiltration and proximal tubule fluid reabsorption in the rat. Circ Res 37: 101–110
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Baba, T., Tomiyama, T., Murabayashi, S. et al. Renal effects of nicardipine, a calcium antagonist, in hypertensive type 2 (non-insulin-dependent) diabetic patients with and without nephropathy. Eur J Clin Pharmacol 38, 425–429 (1990). https://doi.org/10.1007/BF02336678
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02336678