Effects of efonidipine, an L- and T-type calcium channel blocker, on the renin-angiotensin-aldosterone system in chronic hemodialysis patients

Abstract

Components of the renin-angiotensin-aldosterone system such as angiotensin II and aldosterone are believed to contribute to the development and progression of cardiovascular tissue and organ injuries. We compared the effects of two calcium channel blockers, efonidipine and amlodipine, on the renin-angiotensin-aldosterone system in patients with end-stage renal diseases on maintenance hemodialysis. Twenty hypertensive patients on chronic hemodialysis were given efonidipine 20-60 mg twice daily and amlodipine 2.5-7.5 mg once daily for 12 weeks each in a random crossover manner. The average blood pressure was comparable between the efonidipine and am-lodipine periods (151 ± 15/77 ± 8 versus 153 ± 15/76 ± 8 mmHg). The pulse rate did not change signifcantly during the administration periods. Although the plasma renin activity and plasma angiotensin II were not signifcantly different between the efonidipine and amlodipine periods, plasma aldosterone was signifcantly lower in the efo-nidipine period than in the amlodipine period (123 ± 118 versus 146 ± 150 pg/mL, P = 0.027). The fndings suggest that efonidipine reduces plasma aldosterone levels in patients on maintenance hemodialysis, and this seems to be an additional beneft to the cardiovascular protection by antihypertensive therapy with efonidipine in patients with end-stage renal disease.