Manidipine is a lipophilic, third-generation
dihydropyridine calcium channel antagonist with a high degree of selectivity for the vasculature, thereby inducing marked peripheral vasodilation with negligible cardiodepression. In addition,
manidipine does not significantly affect
norepinephrine levels, suggesting a lack of sympathetic activation. It has a gradual onset of action and a long duration of action enabling once daily administration. Furthermore,
manidipine dilates both the efferent and the afferent renal arterioles and appears to have beneficial renal effects unrelated to its
antihypertensive effect. Once-daily oral
manidipine is an effective and generally well tolerated
antihypertensive agent for younger and elderly adult patients with mild-to-moderate
hypertension. In particular, in a large double-blind trial, the incidence of ankle oedema was significantly lower in
manidipine than in
amlodipine recipients.
Manidipine is also effective in hypertensive patients with comorbidities, such as
type 2 diabetes mellitus and/or renal impairment, and appears to improve
insulin sensitivity without affecting metabolic function. Thus,
manidipine represents a first-line treatment option for patients with essential mild-to-moderate
hypertension.