- Hypertension is a common risk factor for cardiovascular disease, and effective blood pressure control is needed to prevent complications. However, most drugs do not reach effective doses due to side effects, and increased pill burden reduces compliance. - There is a need for an optimal drug that acts at multiple levels and can be developed into combination pills with synergistic or complementary action. - The drug cilnidipine inhibits both L-type and N-type calcium channels, providing advantages over traditional calcium channel blockers (CCBs) in reducing blood pressure across patient populations and comorbidities while also reducing proteinuria and edema risk. It is an effective option for hypertension management.

1. UNCOMPLICATED HYPERTENSION
- ROLE OF THE LATEST DHP CCB
Dr. Nagula Praveen, MD,DM
Assistant Professor of Cardiology,
Osmania General Hospital, Hyderabad.
drpraveennagula@gmail.com
Twitter: @kizashipraveen

2. Introduction
• Hypertension is the common risk factor in the cardiovascular disease continuum.
• Effective control of blood pressure is needed to prevent the complications.
• Most of the drugs don’t reach the effective doses due to adverse effects.
• Increased pill burden is also the reason for noncompliance.
• Need of an optimal drug is of utmost important which acts at multiple levels.
• Combination pills to be developed with syngeristic or complementary action.

3. RULE OF HALVES

4. What is (un)complicated hypertension?

5. What is the real problem of hypertension ?

14. Target down?

17. • SCORE the risk

25. The J shape curve – Sail boat

33. We need Optimal drug
to achieve Optimal BP
To reduce target organ damage

35. Why there is need to block
the N type calcium
channels???
N – Neuron related..

38. Cilnidipine vs Amlodipine (Indian study)
• Prospective randomized study in Amritsar, Punjab
• 120 Hypertension patients, two groups each.
• 10 mg cilnidipine vs 5 mg amlodipine
• Change in SBP was assessed in both groups
• Follow up was 3months
• Conclusion – Cilnidipine offers greater reduction of SBP and prevents
ankle edema in HTN patients
ESC 2014

39. HTN IN SPECIAL
POPULATIONS

41. Cilnidipine vs Amlodpine in
HTN + Diabetes (RAS- Inhibition)
Amlodipine Cilnidipine
• Multicenter, randomized, active controlled study
• Korea
• 74 patients
• Diabetes + Hypertension patients
• Cilnidpine 10mg vs Amlodipine 5mg (RASI)
• UACR - Assessed at baseline,12 and 24 weeks.
EASD,Sept 2014

42. • In diabetics, enhanced SNS activity results in constricted efferent arterioles and
elevated intraglomerular pressure.
• Afferent arteriolar dilatation will cause an increase in intraglomerular pressure
(L type CCB)
• Cilnidipine, dilates both afferent and efferent arteriole (N type calcium channels)
– reduces urinary albumin and protein excretion
• Other benefits, decrease in pulse rate, urinary protein excretion and serum
triglycerides.
In CKD pts , cilnidipine has antihypertensive effects
equivalent to amlodipine, but proteinuria was reduced by
shifting from amlodipine to cilnidipine
Indian J Nephrol. 2015 Nov-Dec; 25(6): 334–339.
Cilnidipine benefit in Diabetic Patients

43. Take Home Message
• The drug cilnidipine, inhibits both L and N type channels, rather than
only L type channels by traditional CCBs (Added Advantage).
• It is as effective as traditional CCBs in reducing the BP in HTN
patients of all etiologies and associated comorbidities.
• Other advantages over traditional CCBs
• Reduction in proteinuria
• Lesser risk of pedal edema
• Improvement in cardiac function and uric acid levels.
• It is a effective drug with pleomorphic effects and is a good drug for
management of hypertension.

44. Measure Your Blood Pressure, Control It, Live Long

45. Thank you