Carter trial cilnidipine

Several clinical studies have indicated that cilnidipine, displays better renal protection compared with other antihypertensive drugs, including diuretics and the other dihydropyridine CCBs. The precise mechanisms by which cilnidipine elicits its strong anti-proteinuric effect remain unclear; however, effective podocyte protection may play an important role. Podocytes act as a permeability barrier restricting the passage of large molecules like albumin. Increased amount of albumin in the urine is the primary indication of a defective glomerular filtration barrier, a condition commonly known as "proteinuria" or "albumiuria".

Various glomerular diseases that induce proteinuria also demonstrate significant structural damage to podocytes. Structural damage to podocytes has become the hallmark of proteinuria and serves as the diagnostic marker for various glomerular diseases. Therefore, podocyte injury is considered as an important therapeutic target in hypertensive renal disease. Cilnidipine provides protection of glomeruli by efferent arteriolar vasodilation via attenuation of glomerular hypertension Figure 2.

This is known to significantly reduce glomerular pressure offering effective podocyte protection, which further results in significant anti-proteinuric effect. Kojima S et al compared cilnidipine and amlodipine with respect to their effects on renal function and proteinuria. Amlodipine showed a significant increase in proteinuria, whereas it was suppressed by cilnidipine at 12 months of treatment.

After 12 months, proteinuria and heart rate were significantly decreased in the cilnidipine treated patients, but proteinuria increased and heart rate remained unchanged in patients treated with CCB acting on L-type channel L-CCB. J-Circle study: CCBs in general have no influence on uric acid metabolism. However, the J-CIRCLE study by Uchida S et al conducted to compare the effects of cilnidipine versus amlodipine on albuminuria and uric-acid metabolism, suggest that cilnidipine significantly suppresses uric acid production associated with myogenic hyperuricemia through its dual-blocking actions on L and N types of calcium channels.

CLEARED study demonstrated significant antialbuminuric effect of cilnidipine as compared to other L-type CCBs in type- 2 diabetic patients presenting with normoalbuminuria and microalbuminuria.

Clinically, antialbuminuric effect of cilnidipine was reported to be continued after treatment period for at least 6 months. CARTER study which is a multi-center, open-labeled, and randomized trial compared the antiproteinuric effect of cilnidipine with that of amlodipine in hypertensive patients with kidney disease.

This study suggests that cilnidipine is superior to amlodipine Figure 3 in preventing the progression of proteinuria in hypertensive patients when coupled with a renin-angiotensin system inhibitor. A recently published article showed greater reduction in microalbuminuria in patient treated with enalapril with cilnidipine in comparison with enalapril alone P In animal studies, cilnidipine has been reported to reduce neuronal damage. Thus, the drug may be suitable for hypertensive patients with a risk of brain attack.

Hypertension is one of the most common conditions seen in primary care and if not treated appropriately can lead to various co-morbidities. CCB is one of the first line drugs in the management of hypertension. Cilnidipine by causing less reflex tachycardia, less pedal edema, better control of proteinuria, suppressing podocyte damage, increasing insulin sensitivity has become a CCB of choice in hypertensive patients with diabetes, chronic kidney disease and in patients developing pedal edema with other CCB.

Previous Previous Next Next. Register Now Login. Past Issue: April - Dark mode. ISSN - Abstract Hypertension is one of the most common conditions seen in primary care and a major public health problem in India. As per the latest Eighth Joint National Committee JNC 8 the goal BP in most hypertensive patients age Introduction Hypertension can lead to myocardial infarction, stroke, renal failure, and death if not detected and treated appropriately. Role of Podocytes in Renal Function Podocytes act as a permeability barrier restricting the passage of large molecules like albumin.

Published online December 18, Gupta R, Guptha S. Strategies for initial management of hypertension. Indian J Med Res ; Time to effectively address hypertension in India. Gupta R. Trends in hypertension epidemiology in India. Journal of Human Hypertension ; 73 Ann Intern Med ; Carretero OA, Oparil S. Circulation ; Chandra KS, Ramesh G.

The fourth-generation Calcium channel blocker: Cilnidipine. Indian Heart Journal ; Takahara A. Cardiovascular Therapeutic ; The Journal of Clinical Hypertension ; Ambulatory blood pressure monitoring in patients with essential hypertension treated with a new calcium antagonist, cilnidipine. Cardiovascular Drugs Therapeutics ; Effects of cilnidipine, a novel dihydropyridine calcium antagonist, on autonomic function, ambulatory blood pressure and heart rate in patients with essential hypertension.

Br J Clin Pharmacol ; Kai T, Kuzumto Y. Clin Exp Hypertens ; Bedtime administration of cilnidipine controls morning hypertension. Int Heart J ; J Am Soc Hypertens ; J Clin Hypertens Greenwich ; Effect of a novel calcium channel blocker on abnormal nocturnal blood pressure in hypertensive patients.

Comparison of the effects of cilnidipine and amlodipine on ambulatory blood pressure. Chatzikyrkoyu C. Med Klin Munich Aug; — Chobanian A. Julius S. Sympathetic hyperactivity in early stages of hypertension: the Ann Arbor data set. J Cardiovasc Pharmacol. Weir M. Calcium channel blockers: differences between subclasses. Am J Cardiovasc Drugs. Frishman W. Aoum K. Dihydropyridines from the first to fourth generation: better effects and safety. Singh B. The mechanism of action of calcium antagonists relative to their clinical applications.

Br J Clin Pharmacol. Spedding M. Pharmacol Rev. Toyooka T. Third generation calcium entry blockers. Blood Press. New generation calcium channel blockers in hypertensive treatment. Curr Hypertens Rev. Ertel E. Nomenclature of voltage gated calcium channels. Miljanich G. Annu Rev Pharmacol Toxicol. Hofmann F. Voltage dependent calcium channels: from structure to function. Rev Physiol Biochem Pharmacol. Fujii S. Effect of cilnidipine, a novel dihydropyridine calcium channel antagonist, on N type calcium channel in rat dorsal root ganglion neurons.

J Pharmacol Exp Ther. Uneyama H. Blockade of N type calcium current by cilnidipine FRC in acutely dissociated rat sympathetic neurones. Br J Pharmacol. Eur J Pharmacol. Takahara A. Neuronal calcium channel blocking action of antihypertensive drug, cilnidipine in IMR human neuroblastoma cells. Hypertens Res. Nap A. The evaluation of N type channel blocking properties of cilnidipine and other voltage dependent calcium antagonists.

Fundam Clin Pharmacol. Hosono M. Jpn J Pharmacol. Nagayama T. Effect of cilnidipine, a novel dihydropyridine calcium channel blocker, on adrenal catecholamine secretion in anesthetized dogs. Nagai H. Long term blockade of N type calcium channels reversed the ventricular electrical remodelling in the canine model of long QT syndrome.

Circ J. Saitoh M. Antianginal effects of L type N type calcium channel blocker cilnidipine assessed using vasopressin induced experimental angina model in rats. J Pharmacol Sci. Nagahama S. Iimura O. Study of FRC cilnidipine in patients with severe hypertension.

Jpn Pharmacol Ther. Hoshide S. Comparison of the effects of cilnidipine and amlodipine on ambulatory blood pressure. Ashizawa N. Bedtime administration of cilnidipine controls morning hypertension. Int Heart J. Yamagishi T. Chung W. Effects of cilnidipine versus atenolol on left ventricular diastolic function and hypertrophy in essential hypertension — CANDLE trial.

J Hypertens. Cilnidipine improves left ventricular midwall function independently of blood pressure changes in Chinese patients with hypertension. Domanski M. Vupputuri S. Effect of blood pressure on early decline in kidney function among hypertensive men. Klag M. Blood pressure and end stage disease in men. N Engl J Med. Manjunath G. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community.

J Am Coll Cardiol. Hillege H l, Fidler V. Rose G. Cilnidipine as effective as benazepril for control of blood pressure and proteinuria in hypertensive patients with benign nephrosclerosis. Kojima S. Comparison between cilnidipine and amlodipine besilate with respect to proteinuria in hypertensive patients with renal diseases.

Tsuchihashi T. Antiproteinuric effect of N type calcium channel blocker, cilnidipine. Clin Exp Hypertens. Katayama K. Comparison between valsartan and valsartan plus cilnidipine in type II diabetics with normo- and microalbuminuria. Kidney Int. Fujita T.