Summary
Long term treatment with nifedipine and nitrendipine, but not verapamil and diltiazem, may reduce plasma potassium levels in hypertensive patients. To test the hypothesis that this effect is related to adrenaline-mediated influx of potassium from the extracellular space, the effect of adrenaline infusions (12.5, 25 and 50 ng/kg/min) on plasma potassium levels was assessed in normotensive subjects after administration of placebo for 4 days, and after administration of nitrendipine, verapamil or diltiazem for 4 days. The adrenaline-induced decrease in plasma potassium levels was enhanced in subjects receiving nitrendipine, but was unaffected in those subjects receiving verapamil or diltiazem. The effects of adrenaline on blood glucose levels, heart rate and blood pressure were uninfluenced in subjects receiving nitrendipine or verapamil, and were blunted in subjects receiving diltiazem. These results suggest that enhancement of the adrenaline-induced intracellular transfer of potassium from the extracellular space is relatively specific to dihydropyridine calcium antagonists.
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Beer NA, Jakubowicz DJ, Beer RM, Arocha IR, Nestler JE. Effects of nitrendipine on glucose tolerance and serum insulin and dehy-droepiandrosterone sulfate levels in insulin-resistant obese and hypertensive men. Journal of Clinical Endocrinology and Metabolism 76: 178–183, 1993
Clausen T, Everts ME. Regulation of the Na,K-pump in skeletal muscle. Kidney International 35: 1–13, 1989
De Fronzo RA, Bia M. Extrarenal potassium homeostasis. In Seldin DW & Giebisch G (Eds) The kidney, pp. 1179–1206, Raven Press, New York, 1985
Doyle AE. Comparison of the beta adrenoreceptor blockers and calcium antagonists in hypertension. Hypertension 5 (Suppl. II): II03–II108, 1983
Flaim SF, Irwin JM, Ratz PH, Swigart SC. Differential effects of calcium channel blocking agents on oxygen consumption rate in vascular smooth muscle. American Journal of Cardiology 49: 511–518, 1982
Fritschka E, Distler A, Lenz T, Kribben A, Schudrowitsch L, et al. Effect of nifedipine and verapamil on alpha-receptor-activation in patients with essential hypertension. Journal of Hypertension 2 (Suppl. 3): 535–538, 1984
Kaji DM. Nifedipine inhibits calcium-activated K transport in human erythrocytes American Journal of Physiology 259: C332–C339, 1990
Lederballe-Pedersen O, Mikkelsen E, Christensen NJ, Kornerup HJ, Pedersen EB. Effects of nifedipine on plasma renin, aldosterone and catecholamines in arterial hypertension. European Journal of Clinical Pharmacology 15: 235–240, 1979
Motulsky HJ, Snavely MD, Hughes RJ, Insel PA. Interaction of verapamil and other calcium channel blockers with alpha-1 and alpha-2 adrenergic receptors. Circulation Research 52: 226–230, 1983
Murphy MB, Scriven AJI, Dollery CT. Role of nifedipine in treatment of hypertension. British Medical Journal 287: 257–259, 1983
Pan M, Janis RA. Nimodipine, a new cerebral vasodilator, stimulates Na+,K+ activated ATPase of smooth muscle microsomes Federal Proceedings 41: 1483, 1982
Petersen OH, Maruyama Y. Calcium-activated potassium channels and their role in secretion. Nature 307: 693–696, 1984
Reams GP, Lau A, Hamory A, Bauer JH. Amlodipine therapy corrects renal abnormalities encountered in the hypertensive state. American Journal of Kidney Disease 10: 446–451, 1987
Solomon R, Dubey A, Diltiazem enhances potassium disposal in subjects with end-stage renal disease. American Journal of Kidney Disease 19: 420–426, 1992
Sugarman A, Kahn T. Calcium channel blockers enhance extrarenal potassium disposal in the rat American Journal of Physiology 250: F695–F701, 1986
Sunderrajan S, Reams G, Bauer JH. Renal effects of diltiazem in primary hypertension. Hypertension 8: 238–242, 1986
Taira N. Differences in cardiovascular profile among calcium antagonists American Journal of Cardiology 59: 24B–29B, 1987
Todd EP, Vick R. Kalemotropic effect of epinephrine: analysis with adrenergic agonists and antagonists. American Journal of Physiology 220: 1964–1968, 1971
Zanchetti A, Leonetti G. Natriuretic effects of calcium antagonist. Journal of Cardiovascular Pharmacology 7 (Suppl. 4): S33–S37, 1985
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Mimran, A., Ribstein, J. & Sissmann, J. Effects of Calcium Antagonists on Adrenaline-Induced Hypokalaemia. Drugs 46 (Suppl 2), 103–107 (1993). https://doi.org/10.2165/00003495-199300462-00018
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DOI: https://doi.org/10.2165/00003495-199300462-00018