Recent experimental studies suggest a direct role for aldosterone in cardiovascular pathophysiology. Moreover, the EPHESUS trial (Eplerenone Post-AMI Heart Failure Efficacy and Survival Study) established that addition of the selective aldosterone blocker eplerenone to optimal medical therapy reduces morbidity and mortality in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure (N Engl J Med 348:1309–1321, 2003). The potential mechanisms by which aldosterone may contribute to heart failure and the cardioprotective effects of aldosterone blockade were evaluated using the selective aldosterone blocker, eplerenone, in spontaneously hypertensive heart failure rats (SHHF). Fourteen month old SHHF rats were randomized to receive eplerenone (100 mg/kg/day, EPL), enalapril (10mg/kg/day, ENAL), or eplerenone + enalapril (EPL + ENAL). EPL, ENAL and EPL + ENAL treatment attenuated functional and structural decline and protected target organs. Compared to age-matched Sprague-Dawley controls, untreated SHHF exhibited elevated systolic blood pressure (SBP) (192±6 vs. 135±2 mmHg). ENAL (163±6 mmHg) or EPL + ENAL (151±6 mmHg) significantly decreased SBP, whereas SBP was not significantly reduced with EPL treatment (188±7 mmHg) compared to untreated SHHF (192±6 mmHg). EPL+ENAL improved ejection fraction (53±2 vs. 33±2%) and significantly reduced left ventricular end-diastolic (0.63±0.03 vs. 0.97±0.06 mL) and left ventricular end-systolic volume (0.29±0.02 vs. 0.65±0.05 mL) compared to untreated SHHF. Cardiac and renal histopathology revealed severe vascular injury, necrosis, fibrosis and inflammatory lesions in untreated SHHF. EPL + ENAL treatment attenuated myocardial damage, albuminuria (257.3±62.8 vs. 408.4±84.2 mg/24hr) and myocardial and renal inflammatory marker gene expression compared to untreated SHHF. Circulating osteopontin levels were also markedly reduced (∼3-fold). These data indicate that cardiac and renal damage in this model is accompanied by an aldosterone-mediated inflammatory response and coadministration of EPL + ENAL attenuates vascular inflammation and injury and provides superior target organ protection. Recent experimental studies suggest a direct role for aldosterone in cardiovascular pathophysiology. Moreover, the EPHESUS trial (Eplerenone Post-AMI Heart Failure Efficacy and Survival Study) established that addition of the selective aldosterone blocker eplerenone to optimal medical therapy reduces morbidity and mortality in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure (N Engl J Med 348:1309–1321, 2003). The potential mechanisms by which aldosterone may contribute to heart failure and the cardioprotective effects of aldosterone blockade were evaluated using the selective aldosterone blocker, eplerenone, in spontaneously hypertensive heart failure rats (SHHF). Fourteen month old SHHF rats were randomized to receive eplerenone (100 mg/kg/day, EPL), enalapril (10mg/kg/day, ENAL), or eplerenone + enalapril (EPL + ENAL). EPL, ENAL and EPL + ENAL treatment attenuated functional and structural decline and protected target organs. Compared to age-matched Sprague-Dawley controls, untreated SHHF exhibited elevated systolic blood pressure (SBP) (192±6 vs. 135±2 mmHg). ENAL (163±6 mmHg) or EPL + ENAL (151±6 mmHg) significantly decreased SBP, whereas SBP was not significantly reduced with EPL treatment (188±7 mmHg) compared to untreated SHHF (192±6 mmHg). EPL+ENAL improved ejection fraction (53±2 vs. 33±2%) and significantly reduced left ventricular end-diastolic (0.63±0.03 vs. 0.97±0.06 mL) and left ventricular end-systolic volume (0.29±0.02 vs. 0.65±0.05 mL) compared to untreated SHHF. Cardiac and renal histopathology revealed severe vascular injury, necrosis, fibrosis and inflammatory lesions in untreated SHHF. EPL + ENAL treatment attenuated myocardial damage, albuminuria (257.3±62.8 vs. 408.4±84.2 mg/24hr) and myocardial and renal inflammatory marker gene expression compared to untreated SHHF. Circulating osteopontin levels were also markedly reduced (∼3-fold). These data indicate that cardiac and renal damage in this model is accompanied by an aldosterone-mediated inflammatory response and coadministration of EPL + ENAL attenuates vascular inflammation and injury and provides superior target organ protection.