Choosing the right calcium channel blocker for patients with hypertension and proteinuric chronic kidney disease

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.