title: Protective effect of telmisartan against endothelial dysfunction after coronary drug-eluting stent implantation in hypertensive patients.
abstract: OBJECTIVE
  The aim of this prospective, randomized study was to evaluate the effects of telmisartan, compared with the calcium-channel blocker amlodipine, on endothelial function after coronary drug-eluting stent (DES) implantation in hypertensive patients.
  
  
  BACKGROUND
  DES implantation impairs local endothelial function, which may be associated with future cardiovascular events. Telmisartan, which has unique peroxisome proliferator-activated-receptor-gamma-mediated effects in addition to its renin-angiotensin system-inhibition effects, has favorable effects on endothelial function.
  
  
  METHODS
  Fifty-one hypertensive patients with coronary artery stenosis but without coronary artery spasm, treated with a sirolimus-eluting stent, were randomly assigned to either the telmisartan (25 cases) or amlodipine (26 cases) treatment groups. At baseline and at 3 months after DES implantation, endothelium-dependent and -independent vasomotion were evaluated by quantitative coronary angiography under the condition of medication withdrawal. The mean luminal diameter of a 20-mm coronary segment, beginning 5 mm distal to the stent, was measured before and after infusion of intracoronary acetylcholine (10(-7), 10(-6) mol/l) and then again after infusion of nitroglycerin.
  
  
  RESULTS
  Blood pressure was comparable between groups at baseline and after 3 months. Vasoconstriction after acetylcholine infusion at 3 months (impaired endothelial function) was less pronounced in the telmisartan group than in the amlodipine group (p<0.0001), although there was no significant difference between the 2 groups before DES implantation. The response to nitroglycerin did not differ between groups before or at 3 months after DES implantation.
  
  
  CONCLUSIONS
  Telmisartan, compared with amlodipine, significantly ameliorated endothelial dysfunction after DES implantation in terms of vasoconstriction induced by acetylcholine.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. mterashima-circ@umin.ac.jp
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000295:instrumentation; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000628:therapy; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D000077333:Telmisartan; D014661:Vasoconstriction / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D017311:Amlodipine; D000077333:Telmisartan