The differential effects of angiotensin II type 1 receptor blockers on microalbuminuria in relation to low-grade inflammation in metabolic hypertensive patients.
BACKGROUND
A dual angiotensin type 1 receptor blocker (ARB)/peroxisome proliferator-activated receptor-gamma (PPARgamma) agonist telmisartan may be more useful for microalbuminuria reduction than ARBs with no PPARgamma agonistic action. We investigated whether there is a difference between the effects of telmisartan and valsartan with respect to microalbuminuria reduction, and the association with improvement of metabolic features or suppression of the inflammatory state.


METHODS
Fifty-three patients who had metabolic syndrome and had been taking valsartan were recruited. All of these patients were randomly assigned to replace valsartan by telmisartan (telmisartan group; n = 30) or to keep taking valsartan (control group; n = 21). Various parameters were measured at baseline and 12 weeks after randomization.


RESULTS
There were no significant changes in blood pressure (BP), glucose, and lipid parameters between baseline and 12 weeks after randomization in either group. There was a significant increase in high molecular weight adiponectin in the telmisartan group (4.6 v 5.0 microg/mL, P = .024), whereas there was no significant change in the control group. The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group (28.1 v 18.9 mg/g.Cr and 0.77 v 0.60 mg/L, respectively, P = .001 and P = .022), whereas there was no significant change in the control group. The reductions of microalbuminuria and hs-CRP were significantly correlated with each other (gamma = 0.413, P = .003).


CONCLUSIONS
The dual ARB/PPARgamma agonist telmisartan achieved more microalbuminuria reduction than an ARB with no PPARgamma agonistic action, possibly through suppression of the inflammatory state in metabolic hypertensive patients.
Yano
Yuichiro
Y
Department of Internal Medicine, Misato Town National Health Insurance Nango Hospital, Miyazaki, Japan.
Hoshide
Satoshi
S
Ishikawa
Joji
J
Noguchi
Chishio
C
Tukui
Daisuke
D
Takanori
Hidaka
H
Tada
Masashi
M
Kanemaru
Yoshimasa
Y
Yano
Ayako
A
Ishikawa
Shizukiyo
S
Shimada
Kazuyuki
K
Kario
Kazuomi
K
D000368:Aged; D000419:Albuminuria / Q000188:drug therapy* / Q000209:etiology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D047495:PPAR gamma / Q000819:agonists; D000077333:Telmisartan; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D047495:PPAR gamma; D002097:C-Reactive Protein; D000077333:Telmisartan