A recent study suggests that dihydropyridine calcium-channel blockers, commonly prescribed for hypertension in diabetic patients, may be associated with increased risks of kidney deterioration, prompting calls for further investigation into safer treatment strategies.
New findings presented at the 63rd European Renal Association Congress suggest that a widely used class of blood pressure medicine may be linked to poorer kidney outcomes in people with type 2 diabetes, including those already taking drugs designed to protect kidney function.
The medicines, known as dihydropyridine calcium-channel blockers, work by widening blood vessels and are often used when first-line treatment is not enough. In people with diabetic kidney disease, they are commonly added to renin-angiotensin system inhibitors and sodium-glucose cotransporter-2 inhibitors, two drug classes now central to modern care because they can help limit pressure inside the kidneys and slow progression towards kidney failure.
In the study, researchers analysed health records for 31,031 adults with type 2 diabetes treated between 2016 and 2021. All were receiving both renin-angiotensin system inhibitors and SGLT2 inhibitors. Of these, 12,172 were also taking dihydropyridine calcium-channel blockers, while the rest were treated with other blood pressure medicines. After a median follow-up of about 3.5 years, the group taking dihydropyridine calcium-channel blockers had a 33% higher risk of major adverse kidney events, even after accounting for baseline differences.
The events studied included a fall of at least 40% in estimated glomerular filtration rate, or eGFR, a standard measure of kidney function, as well as end-stage kidney disease requiring dialysis or transplantation. Lead author Timna Agur said the results raise questions about whether these drugs are always the best second-line option for patients with diabetic kidney disease already on newer kidney-protective treatment. The researchers think the effect may reflect the way these medicines alter blood flow within the kidney’s filtering units, potentially increasing pressure there and worsening damage.
The findings build on earlier research. A study published in 2024 also linked dihydropyridine calcium-channel blocker use with more severe albuminuria and, in some settings, kidney failure requiring replacement therapy. But because the new work was observational, it cannot prove the drugs caused the worse outcomes. Agur said further prospective studies and randomised trials are needed to identify the safest blood pressure strategy for people with diabetic kidney disease.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
