Therapeutic Usefulness of a Novel Calcium Channel Blocker Azelnidipine in the Treatment of Hypertension: A Narrative Review

Abstract

The prevalence of hypertension and comorbidities such as metabolic syndrome, diabetes mellitus, and chronic kidney disease in India is alarmingly high. Amlodipine, an older-generation calcium channel blocker (CCB), is currently the gold standard for hypertension management in India. However, it has several disadvantages, including reflex tachycardia and pedal edema. Therefore, an effective antihypertensive agent that does not cause these adverse effects and provides end-organ protection is required for the holistic management of hypertension in the country. Azelnidipine is a new-generation CCB that has recently been approved for the treatment of hypertension in India. This review provides an overview of the utility of azelnidipine for hypertension control, including comparisons with traditional CCBs such as amlodipine. It discusses the key antihypertensive effects of azelnidipine as well as its advantages in the prevention of tachycardia and associated complications. In addition, this review highlights the extensive cardio- and renoprotective activities of azelnidipine, including its effects on systolic and diastolic function and urinary albumin excretion. Overall, this substantial body of evidence supports the use of azelnidipine for the treatment of hypertension, especially in India. It suggests that the adoption of azelnidipine as the new gold standard CCB could help India battle its hypertension epidemic.

Keywords: Antihypertensive agents; Azelnidipine; Calcium channel blockers; Chronic renal insufficiency; Diabetes mellitus; Hypertension; India; Metabolic syndrome.

Fig. 1

Schematic illustrating the different types of calcium channel blockers and the types of calcium channels that they target. AML amlodipine, AZE azelnidipine, CIL cilnidipine, DIL diltiazem, EFO efonidipine, NIF nifedipine

Fig. 2

The multifactorial actions of azelnidipine. AS aldosterone secretion, BP blood pressure, HR heart rate, IGP intraglomerular pressure

Fig. 3

The a blood pressure- and b heart rate-lowering effects of azelnidipine (data from Hirai et al. 1999 [24] and Inomata et al. 2014 [16]). AZE azelnidipine, BP blood pressure, HR heart rate

Fig. 4

Mechanisms underlying the effects of azelnidipine on renal glomeruli. AML amlodipine, AZE azelnidipine, CCB calcium channel blocker

Fig. 5

Comparative effects of azelnidipine and amlodipine on a urinary albumin and b C-reactive protein levels (data from Abe et al. [69]). AML amlodipine, AZE azelnidipine, Cr creatinine, CRP C-reactive protein