title: To compare the effect of Telmisartan with Metoprolol on arterial stiffness in hypertension: prospective randomized parallel group trial.
abstract: BACKGROUND
  Hypertension is often complicated by increased arterial stiffness and is an independent predictor of adverse cardiovascular (CV) outcome. Beta blockers and angiotensin receptor blockers (ARBs) are commonly used antihypertensive agents. The effect of beta blockers and ARBs on arterial stiffness has not been compared adequately. The aim of the present study is to compare the effect of telmisartan with metoprolol on arterial stiffness in hypertensive patients in prospective open label randomized parallel group intervention study.
  
  
  METHODS
  100 patients of hypertension, not on any antihypertensive agents, were enrolled after obtaining informed consent. Baseline recording of data related to demographics, CV risk factors, anthropometry and BP were made. Arterial stiffness was measured noninvasively by recording pulse wave velocity (PWV) using periscope (Genesis medical system). Left ventricular (LV) mass was measured using 2D guided M-mode echocardiography. Blood sugar, renal function, lipids and uric acid estimations were done in fasting state. Patients were randomized to receive metoprolol and telmisartan using stratified randomization technique. Dose of the study drugs were titrated to achieve target BP of <140/90 mmHg. Data related to PWV, BP, anthropometry and blood biochemistry was repeated after 6 months of treatment with study drugs.
  
  
  RESULTS
  Telmisartan resulted in significantly greater reduction in arterial stiffness index (ASI) in left and right lower limb arterial bed (39.9 ± 11.7 vs. 46.8 ± 17.0 m/s, p < 0.02) and (36.4 ± 9.6 vs. 44.86 ± 15.1 m/s, p < 0.002) respectively and systolic blood pressure (SBP) (-4.9 mmHg with 95% C.I. of -8.0-1.7 mmHg, p < 0.003) compared to metoprolol. Reduction in diastolic blood pressure (DBP) in telmisartan and metoprolol groups was not different statistically (-1.0 mmHg with 95% C.I. of -3.3-1.2 mmHg, p < 0.3). The change in LV mass was not significantly different between the study groups (135.5 ± 37.6 vs. 143.2 ± 41.5, p < 0.3).
authors.affiliation: Senior Resident, Department of Pharmacology, IGMC, Shimla, India. Electronic address: drms2002@rediffmail.com.
authors.forename: Minakshi
authors.initials: M
authors.lastname: Sumbria
authors.affiliation: Prof and Head, Department of Cardiology, IGMC, Shimla, India.
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Negi
authors.affiliation: Prof and Head, Department of Pharmacology, IGMC, Shimla, India.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Sahai
authors.affiliation: Associate Professor, Department of Pharmacology, IGMC, Shimla, India.
authors.forename: Purshotam K
authors.initials: PK
authors.lastname: Kaundal
mesh_terms: D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D000077333:Telmisartan; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D001562:Benzimidazoles; D001565:Benzoates; D008790:Metoprolol; D000077333:Telmisartan
keywords: CFPWV – carotid femoral pulse wave velocity; LAASI – left ankle arterial stiffness index; LBASI – left brachial arterial stiffness index; RAASI – right ankle arterial stiffness index; RBASI – right brachial arterial stiffness index