Direct comparison of the effects of valsartan and amlodipine on renal hemodynamics in human essential hypertension

Am J Hypertens. 2003 Dec;16(12):1030-5. doi: 10.1016/j.amjhyper.2003.07.017.


Background: To elucidate the renoprotective mechanism of AT(1)-receptor blockers, we compared the effects of the AT(1)-receptor blocker valsartan with those of the calcium channel blocker amlodipine on renal hemodynamics and microcirculation.

Methods: A total of 58 patients (50.2 +/- 9.0 years) with mild to moderate essential hypertension were included in a randomized, double-blind study to receive either valsartan (80 to 160 mg) or amlodipine (5 to 10 mg). Renal plasma flow (RPF) and glomerular filtration rate (GFR) were measured before and after 8 weeks of treatment. Glomerular hydrostatic pressure (P(Glo)) and resistances of the afferent (R(A)) and efferent (R(E)) arterioles were calculated according to the Gomez formulas.

Results: Blood pressure control was similar in both groups. RPF did not change with either treatment. In contrast, GFR increased with amlodipine (+8 +/- 14 mL/min; P <.01) but was preserved with valsartan. Amlodipine caused a more marked increase in the R(E)/R(A) ratio than valsartan (+0.26 +/- 0.26 v +0.13 +/- 0.24, P <.05), which was paralleled by an increase in P(Glo) in patients treated with amlodipine (+1.9 +/- 4.3 mm Hg; P <.05) but not in those treated with valsartan.

Conclusions: At similar blood pressure control, valsartan maintained GFR and P(Glo), whereas amlodipine led to glomerular hyperfiltration and an increase in P(Glo). The results might explain the favorable renal outcome with AT(1)-receptor blocker therapy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amlodipine / pharmacology*
  • Amlodipine / therapeutic use
  • Antihypertensive Agents / pharmacology*
  • Antihypertensive Agents / therapeutic use
  • Double-Blind Method
  • Glomerular Filtration Rate / drug effects*
  • Humans
  • Hypertension / drug therapy
  • Microcirculation / drug effects
  • Middle Aged
  • Renal Circulation / drug effects*
  • Tetrazoles / pharmacology*
  • Tetrazoles / therapeutic use
  • Valine / analogs & derivatives
  • Valine / pharmacology*
  • Valine / therapeutic use
  • Valsartan


  • Antihypertensive Agents
  • Tetrazoles
  • Amlodipine
  • Valsartan
  • Valine