Effects of calcium antagonist, benidipine, on the progression of chronic renal failure in the elderly: A 1-year follow-up

The number of patients who needs for dialysis therapy is increasing rapidly among the older population. Although control of hypertension can delay or arrest the progression of renal failure, there are lacking of studies about antihypertensive treatment of chronic renal failure in the elderly. We hav e studied the effects of treating hypertension with a calcium antagonist, b enidipine, on renal function and blood pressure in 58 patients (mean age: 7 1 +/-9) with hypertension and chronic renal insufficiency (the levels of cr eatinine ranging from 1.5 to 4.0 mg/dl). The underlying disease included gl omerulopathies (in 33), diabetic nephropathy (in 15), and other causes (in 10). Forty two patients who had been treated with other antihypertensive dr ugs other than angiotensin converting enzyme (ACE) inhibitors, antihyperten sive drugs were withdrawn 2 weeks before the entry. At the entry, patients should have sitting systolic blood pressure (SBP) of above 160 mmHg and dia stolic blood pressure (DBP) of above 90 mmHg. In total, both SEP and DBP de creased from 169/95 +/- 12.5/8.9 to 148/81 +/- 16.1/8.0 mmHg (p <0.001) wit h remaining the serum creatinine levels from 2.2 +/-0.8 vs 2.4 +/-1.3 mg/dl (P >0.05). Retrospective analysis revealed that in 4 of 4 patients treated with benidipine and 2 of 3 patients with benidipine and ACE inhibitors with systolic blood pressure more than 160 mmHg at the end of the study, the le vels of serum creatinine increased from 2.5 +/-0.3 to 2.8 +/-0.4 with signi ficance (P <0.05). If systolic blood pressure was reduced less than 159 mmH g, 38 of 48 patients did not show any deterioration of renal function. Comp ared to the significance of SEP in preserving renal function. DBP did not a ssociate with the changes in renal function. No patients died during the st udy. One patient had transient ischemic attack and one patient had stroke i n benidipine treated group. One patient had angina pectoris in benidipine-A CE inhibitors treated group. The results of our trial seem to give some support for the idea that long-a cting calcium antagonists such as benidipine are renoprotective through red uction of SEP in the elderly people with hypertension and chronic renal ins ufficiency. However, if systolic blood pressure was not reduced below 160 m mHg throughout a year, the substantial declines in renal function would be expected.