Chronic renal and neurohumoral effects of the calcium entry blocker nisoldipine in patients with congestive heart failure

Nisoldipine, a calcium entry blocker, was given to 10 patients with congestive heart failure. During a 2 month follow-up period, 7 of the 10 patients were readmitted with pulmonary edema; daily furosemide doses were increased (128 ± 87 to 192 ± 135 mg/day, p −5 , p 2 , p However, nisoldipine's chronic renal and neurohumoral effects were not as favorable. These were assessed during a 5 hour water load (15 ml/kg body weight of 5% dextrose in water) and compared with the effects of a water load before therapy. Nisoldipine did not change creatinine clearance or sodium excretion, but decreased water excretion (from 58 ± 35 to 46 ± 40% of water load in 5 hours). Over this 5 hour study, mean plasma vasopressin was also higher with nisoldipine (1.9 ± 2.3 versus 2.7 ± 3.2 pg/ml, p It is concluded that by causing further neurohumoral activation, nisoldipine may worsen the symptoms of congestive heart failure.