Abstract

Inflammation, insulin resistance and oxidative stress (OS), are among the mechanisms that have been implicated in pathogenesis of essential hypertension (EH). Peripheral polymorphonuclear leukocytes (PMNLs) are primed in EH patients, releasing uncontrolled superoxide anion contributing to OS in these patients. PMNL priming correlates with insulin resistance and with PMNL intracellular calcium ([Ca²⁺]_i). Recent studies have attributed to the anti-hypertensive drug lercanidipine, a third generation calcium-channel blocker, and additional anti-ischemic and anti-oxidative characteristics. To evaluate the possible non-traditional effect of two months of lercanidipine treatment on insulin resistance and on PMNL-related inflammation in EH patients. Non-smoking EH patients with untreated mild to moderate high blood pressure (BP) were included. Low-graded inflammation was reflected by WBC and PMNL counts and by PMNL apoptosis. Systemic inflammation was measured by plasma fibrinogen, C-reactive protein (CRP) and albumin levels. Fasting serum insulin levels served as a marker of insulin resistance. Two months of lercanidipine treatment showed significant decrease in BP, WBC and PMNL counts, and also in PMNL apoptosis, CRP and serum insulin levels and significant increase in serum albumin levels. Rates of superoxide release from PMNLs, WBC and PMNL counts and insulin levels positively correlated with mean arterial blood pressure values. We imply that use of lercanidipine can be favored in EH patients due to its combined anti-PMNL priming and anti-inflammatory effects, in addition to its anti-hypertensive characteristics.

Key words: Essential hypertension, lercanidipine, low-graded inflammation, primed polymorphonuclear leukocytes, oxidative stress.

Abbreviation

Abbreviations: [Ca²⁺]_i, Intracellular calcium; CCB, calcium channel blocker; DBP, diastolic blood pressure; EH, essential hypertension; MAP, mean arterial pressure; NC, healthy subjects; OS,oxidative stress; PMA, phorbol 12-myristate 13-acetate; PBS, phosphate buffered saline; PMNLs,polymorphonuclear leukocytes; SBP, systolic blood pressure; WBC, white blood cells, HD,hemodialysis; CKD, chronic kidney disease.