A certain percentage of aldosterone (ALD) breakthrough generally occurs in patients with hypertension and chronic heart failure and is an important issue during long-term treatment with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB). It has been reported that efonidipine decreases the plasma levels of ALD. However, the long-term effects of efonidipine on the plasma levels of ALD and the left ventricular mass index (LVMI) remain unknown in patients with hypertension. Sixty stable outpatients with essential hypertension who had received amlodipine and ACE-I or ARB for more than 1 year were randomized into two groups (amlodipine group (n¼30): continuous amlodipine treatment at a stable dose; efonidipine group (n¼30): amlodipine (5 mg day À1 ) was changed to efonidipine at a dose of 40 mg day À1 ). There was no difference in their baseline characteristics including the LVMI and plasma levels of ALD. In the amlodipine group, there were no significant changes in blood pressure, LVMI or plasma levels of ALD for 18 months. In the efonidipine group, blood pressure did not change after replacement of amlodipine with efonidipine, although there was a significant decrease in the plasma levels of ALD after 6 months. The decrease in ALD was sustained for 18 months and LVMI was significantly decreased after 18 months (121 ± 25 vs. 114 ± 21 g m À2 , Po0.05). There was a significant correlation between the changes in LVMI and % changes of ALD in the efonidipine group. These findings indicate that the effect of efonidipine on the suppression of plasma ALD was sustained for at least 18 months and that long-term efonidipine therapy decreases LVMI in patients with essential hypertension.
INTRODUCTIONRecent clinical trials have shown that inhibiting the biological actions of aldosterone (ALD) using an ALD blocker alone or in combination with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) is reported to be a useful add-on therapy in hypertensive patients, reducing the incidence of cardiovascular events among patients with chronic heart failure (CHF). 1,2 Therefore, to prevent cardiovascular disease, targeting ALD synthesis and release may be clinically important. One of the major incentives for implementing the RALES and EPHESUS trial was the investigation of the ALD breakthrough phenomenon 3,4 in which ACE-I does not reliably induce significant decreases in plasma ALD levels. Therefore, in a certain percentage of patients with hypertension or CHF, ALD breakthrough generally occurs. This phenomenon is an important issue during a long-term treatment with ACE-I and ARB. 1,[5][6][7][8][9][10][11] Although the mechanisms of ALD breakthrough remain obscure, there was no apparent reduction of the left ventricular mass index (LVMI) in patients with ALD breakthrough(+) during the administration of ACE-I. 8 Aldosterone production in the adrenal gland is mediated mainly by the T-type calcium channel in vitro. 12 Recently, it has been reported that efonidipine, a...