Calcium antagonists and the progression of chronic renal failure.

End-stage renal disease, which signifies irreversible renal failure, constitutes a major and growing public health problem worldwide. The striking increase in end-stage renal disease has catalyzed clinical and investigative focus on pharmacologic interventions to retard progression to this condition. Increasing evidence indicates that some classes of antihypertensive medications may confer a greater effect than others in slowing progression of renal disease despite similar levels of blood pressure reduction. Substantive data indicate that angiotensin converting enzyme inhibition preferentially retards the progression of renal disease, primarily by protecting the injured kidney from hemodynamically mediated glomerular damage. Newer studies suggest that calcium antagonists also have diverse properties, which are independent of their renal microcirculatory effects that might afford renal protection.