The angiotensin II type 1 receptor blocker azilsartan can overwhelm the sympathetic nerve activation stimulated by coadministration of calcium channel blockers

Objective: In our recent study, non-Gaussianity of heart rate variability (lambda(25s)), an indicator of sympathetic nerve activity, did not change during two-day treatment with the angiotensin II type 1 receptor blocker (ARB) azilsartan. Coadministration of calcium channel blockers (CCBs) might affect the study results. Methods: In this subanalysis, 20 patients with chronic kidney disease (14 men; age 61 +/- 15 years) were divided into three groups: patients with coadministration of L-type CCB, patients without coadministration of CCB, and patients with coadministration of sympathoinhibitory (L/T- or L/T/N-type) CCB. lambda(25s) was calculated separately in daytime and nighttime. Results: Daytime lambda(25s) at baseline was higher in patients with L-type CCB coadministration (0.62 +/- 0.18, n = 5) compared with those without CCB (0.49 +/- 0.13, n = 11) and those with sympathoinhibitory CCB (0.46 +/- 0.06, n = 4). The relationship between the changes in daytime lambda(25s) and systolic blood pressure was positive in patients with L-type CCB coadministration, whereas the relationship was inverse in the other two groups. A larger decrease in daytime lambda(25s) was shown in patients with L-type CCB coadministration compared with those in the other two groups. Conclusions: CCBs, as well as diuretics, are recommended as second-line antihypertensive agents. Our results suggested that ARBs can overwhelm the activation of sympathetic nerve activity stimulated by coadministration of L-type CCBs.