Therapeutic strategy for the treatment with hypertensive renal injury

Hypertension constitutes a pivotal determinant of the progression of renal disease, which would raise the risk for cardiovascular events. From the standpoint of renal micro-circulation, correction of glomerular hypertension could retard the development of renal injury, which is attainable by the reduction in renal efferent arteriolar resistance as well as systemic blood pressure. Although both ACE inhibitors and angiotensin receptor blockers are established as a tool for improving glomerular hypertension, whether calcium antagonists ameliorate this abnormality remains unclear. However, recent clinical trials including ALLHAT and INSIGHT demonstrate a beneficial action of amlodipine and nifedipine on the development of renal injury. Therefore, calcium antagonists can be used not only as a first line drug, but also as add-on therapy that could potentiate the hypotensive action of underlying medication.