Choosing the right calcium channel blocker for patients with hypertension and proteinuric chronic kidney disease.

Daniele Romanello, Gabriele D'Urso, Annalisa Noce, Maria Josè Ceravolo, Camillo Ricordi, Marco Infante, Manfredi Tesauro, David Della-Morte, Luca Di Lullo, Paolo Lido, Stefano Rezk

Journal: Current medical research and opinion 2025;41(7):1333-1351

PMID: 40765180

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Abstract

Arterial hypertension and diabetes mellitus represent major modifiable risk factors for the occurrence of cardiovascular disease, development of chronic kidney disease (CKD) and progression of CKD to end-stage renal disease (ESRD). In view of the rising burden of hypertension, diabetes mellitus and CKD on a global scale, there is currently a great need for drugs that can effectively prevent the onset and reverse or slow down the progression of CKD in diverse patient populations. Over the last decades, a growing body of evidence has demonstrated that calcium channel blockers (CCBs) can exert cardioprotective and nephroprotective actions. In the present narrative review, we aimed to specifically describe the cardiorenal protective effects of dihydropyridine CCBs (particularly lercanidipine and manidipine, based on the available evidence) and non-dihydropyridine CCBs (verapamil and diltiazem). With regard to this research topic, we also reviewed the 2023 European Society of Hypertension (ESH) Guidelines for the management of arterial hypertension [endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)] and the 2023 European Society of Cardiology (ESC) Guidelines for the management of cardiomyopathies. Finally, we proposed practical criteria for prescribing the most appropriate CCB (among dihydropyridine CCBs and non-dihydropyridine CCBs) for patients with hypertension and proteinuric CKD (with or without diabetes) in different clinical settings.

Address: Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.; Nephrology and Dialysis Unit, Azienda USL Roma 6, Albano Laziale, Italy.; Section of Diabetes & Metabolic Disorders, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy.; Division of Cellular Transplantation, Cell Transplant Center, Diabetes Research Institute (DRI), Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.; Division of Cellular Transplantation, Cell Transplant Center, Diabetes Research Institute (DRI), Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.; Section of Diabetes & Metabolic Disorders, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy.; Department of Internal Medicine, San Pietro Fatebenefratelli Hospital, Rome, Italy.; Nephrology and Dialysis Unit, Department of Systems Medicine, Policlinico Tor Vergata Hospital, Rome, Italy.; Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.; Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.; Nephrology and Dialysis Unit, Department of Systems Medicine, Policlinico Tor Vergata Hospital, Rome, Italy.; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

DOI: 10.1080/03007995.2025.2544594

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https://www.tandfonline.com/doi/10.1080/03007995.2...

MeSH Terms: Humans, Calcium Channel Blockers, Hypertension, Renal Insufficiency, Chronic, Proteinuria, Dihydropyridines, Practice Guidelines as Topic, Diltiazem, Verapamil