Lido Paolo, Di Lullo Luca, Infante Marco, Ricordi Camillo, Rezk Stefano, Romanello Daniele, D'Urso Gabriele, Ceravolo Maria Josè, Della-Morte David, Tesauro Manfredi, Noce Annalisa
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.
Curr Med Res Opin. 2025 Jul;41(7):1333-1351. doi: 10.1080/03007995.2025.2544594. Epub 2025 Aug 14.
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.
动脉高血压和糖尿病是心血管疾病发生、慢性肾脏病（CKD）发展以及CKD进展至终末期肾病（ESRD）的主要可改变风险因素。鉴于全球范围内高血压、糖尿病和CKD负担不断加重，目前迫切需要能有效预防CKD发病并逆转或减缓其在不同患者群体中进展的药物。在过去几十年中，越来越多的证据表明钙通道阻滞剂（CCB）可发挥心脏保护和肾脏保护作用。在本叙述性综述中，我们旨在具体描述二氢吡啶类CCB（根据现有证据，特别是乐卡地平与马尼地平）和非二氢吡啶类CCB（维拉帕米与地尔硫䓬）的心脏肾脏保护作用。关于这一研究主题，我们还回顾了2023年欧洲高血压学会（ESH）动脉高血压管理指南[得到国际高血压学会（ISH）和欧洲肾脏协会（ERA）认可]以及2023年欧洲心脏病学会（ESC）心肌病管理指南。最后，我们提出了在不同临床环境中为高血压合并蛋白尿性CKD（伴或不伴糖尿病）患者开具最合适CCB（二氢吡啶类CCB和非二氢吡啶类CCB）的实用标准。
