In the treatment of hypertension in renally impaired patients, normalization of 
blood pressure alone may not be sufficient to prevent significant morbidity to 
the kidneys. Treatment must reduce pressure in the renal vasculature, otherwise 
glomerular filtration rate and renal plasma flow will continue to deteriorate. 
Isradipine a dihydropyridine calcium-channel blocker, has been investigated as a 
suitable treatment in this setting. Isradipine maintains glomerular filtration 
rate, preserves or enhances renal plasma flow, decreases renal vascular 
resistance, maintains or reduces filtration fraction, and exerts a sustained 
natriuretic effect, all of which may enable isradipine to slow the rate of 
progression of renal deterioration. In addition, isradipine may decrease 
proteinuria and may decrease glomerular capillary pressure by dilating both the 
efferent and afferent arterioles. Unlike older calcium-channel blockers, 
isradipine exhibits minimal cardiodepressant activity and is not associated with 
any negative inotropic effects. It is metabolized in the liver and dosage 
adjustments may not be necessary when administered to patients with renal 
insufficiency. Isradipine has a favorable renal effect profile and also has 
several properties that meet the requirements of other patient populations where 
an extra measure of antihypertensive safety is required, such as diabetics, 
dialysis patients, and transplant recipients. Side effects with isradipine are 
usually mild and transient, occurring in a dose-dependent manner.