Effects of amlodipine and valsartan on oxidative stress and plasma methylarginines in end-stage renal disease patients on hemodialysis

Kidney Int. 2006 Dec;70(12):2109-15. doi: 10.1038/sj.ki.5001983. Epub 2006 Oct 25.


Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment have a markedly shortened life expectancy in large part owing to cardiovascular disease (CVD), not explained by established risk factors. We tested the hypothesis that therapy with valsartan, an angiotensin receptor blocker and amlodipine, an antioxidant calcium channel blocker will reduce oxidative stress and the plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. We confirmed that compared with age- and gender-matched healthy controls, ESRD patients have excessive oxidative stress and arginine methylation as indexed by elevated plasma levels of oxidation products of lipids (13-hydroxyoctadecadienoic acid (13-HODE)), thiols (oxidized:reduced glutathione, oxidized glutathione (GSSG):GSH), proteins, and nucleic acids, and the methylation products ADMA and symmetric dimethylarginine (SDMA). We undertook a double blind, crossover study of equi-antihypertensive treatment with amlodipine and valsartan for 6 weeks each to test our hypothesis. Both treatments significantly reduced GSSG:GSH, 8-hydroxy 2-deoxyguanosine, ADMA, and SDMA levels and amlodipine reduced 13-HODE. We conclude that hypertensive patients with ESRD receiving HD have evidence of extensive oxidation of lipids, thiols, proteins, and nucleic acids and methylation of arginine that could contribute to CVD. Many of these changes can be reduced by short-term treatment with amlodipine and valsartan.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amlodipine / administration & dosage*
  • Angiotensin II Type 1 Receptor Blockers / administration & dosage*
  • Arginine / analogs & derivatives*
  • Arginine / blood
  • Blood Pressure / drug effects
  • Calcium Channel Blockers / administration & dosage*
  • Cross-Over Studies
  • Female
  • Humans
  • Hypertension, Renal / drug therapy
  • Hypertension, Renal / metabolism
  • Kidney Failure, Chronic / drug therapy*
  • Kidney Failure, Chronic / metabolism
  • Male
  • Methylation / drug effects
  • Middle Aged
  • Oxidative Stress / drug effects
  • Renal Dialysis
  • Tetrazoles / administration & dosage*
  • Valine / administration & dosage
  • Valine / analogs & derivatives*
  • Valsartan


  • Angiotensin II Type 1 Receptor Blockers
  • Calcium Channel Blockers
  • Tetrazoles
  • Amlodipine
  • N,N-dimethylarginine
  • Valsartan
  • Arginine
  • Valine