This study was designed to investigate whether the LJN-type calcium channel blocker, cilnidipine, had a renoprotective effect compared with other calcium channel blockers. Twenty-five hypertensive patients with concomitant type 2 diabetes who had a urinary albumin-creatinine ratio (ACR) of 10-300 mg albuminJg creatinine and who had been treated with oral calcium channel blockers other than cilnidipine for more than 3 months were included. Patients' medication was changed to cilnidipine 10 mgJday or 20 mgJday without a washout period. Blood pressure and renal function were measured before and at 3 months after the new treatment. Heart rate was also determined as a marker for sympathetic nervous activity. After substitution of cilnidipine, blood pressure did not change significantly, but heart rate decreased significantly from 73.9 ±7.1 beatsJmin to 72.0 ± 8.4 beatsJmin, and the log-transformed urinary ACR decreased to 82.9 ± 49.4% of baseline values. The changes in urinary ACR and heart rate showed a significant positive correlation. Thus, there was a strong indication that cilnidipine may exert its renoprotective effect by inhibiting sympathetic nervous activity.
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