Telmisartan improves endothelial function in patients with essential hypertension.
BACKGROUND
: Hypertension is a cardiovascular risk factor commonly associated with endothelial dysfunction and increased renal vascular resistance. Angiotensin receptor blockers (ARBs) may beneficially affect these parameters via antagonism of angiotensin type 1 (AT1) receptor-mediated vasoconstriction and vascular superoxide production. We therefore investigated whether the new ARB telmisartan improves endothelial function and renal vascular resistance in patients with essential hypertension.


METHODS
: Thirty-seven patients with essential hypertension were randomized to receive telmisartan, the calcium channel blocker nisoldipine, or their combination for 6 weeks in a prospective, parallel group study. Brachial artery flow-mediated (endothelium-dependent) dilation (FMD) and renal vascular resistance index (RVRI) were evaluated using high-resolution ultrasound before, at 3 weeks (low dose), and at 6 weeks (high dose) after initiation of treatment.


RESULTS
: At baseline, FMD and RVRI did not significantly differ between treatment groups. After 3 weeks of treatment neither treatment significantly changed FMD or RVRI. After 6 weeks of treatment, patients randomized to receive telmisartan alone or the combination, but not those treated with nisoldipine alone, displayed a significantly improved FMD, whereas RVRI values again were not significantly different as compared to those at baseline.


CONCLUSIONS
: In our study cohort of patients with essential hypertension, treatment with telmisartan improved FMD but did not change RVRI. Future studies will demonstrate whether this telmisartan-induced effect may contribute to a blood pressure-independent reduction in cardiovascular morbidity.
Clinical Pharmacology Unit, Institute of Experimental and Clinical Pharmacology, University Medical Center, Hamburg-Eppendorf, Germany. benndorf@uke.uni-hamburg.de
Ralf A
RA
Benndorf
Daniel
D
Appel
Renke
R
Maas
Edzard
E
Schwedhelm
Ulrich O
UO
Wenzel
Rainer H
RH
Böger
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D001565:Benzoates / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000098:blood supply / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015737:Nisoldipine / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D000077333:Telmisartan; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D015737:Nisoldipine; D000077333:Telmisartan