title: Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study.
abstract: BACKGROUND
  HIV-infected persons are at increased cardiovascular disease (CVD) risk, but traditional CVD therapies are understudied in this population. Telmisartan is an angiotensin receptor blocker (ARB) and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonist that improves endothelial function and cardiovascular mortality in HIV-uninfected populations. We assessed the effects of telmisartan on endothelial function in older HIV-infected persons at risk for CVD in a small pilot study.
  
  
  METHODS
  HIV-infected individuals≥50 years old on suppressive antiretroviral therapy (ART) with ≥1 traditional CVD risk factor received open-label telmisartan 80 mg daily for 6 weeks. Brachial artery flow-mediated dilation (FMD) measured endothelial function. The primary endpoint was 6-week change in maximum relative FMD.
  
  
  RESULTS
  Seventeen participants enrolled; 16 completed all evaluations (88% men, 65% non-White, median age 60 years, CD4+T lymphocyte count 625 cells/mm3). Antiretroviral therapy included 71% protease inhibitor (PI), 29% non-nucleoside reverse transcriptase inhibitor (NNRTI), 29% integrase inhibitor, 65% tenofovir, and 29% abacavir. Cardiovascular disease risk factor prevalence included 76% hyperlipidemia, 65% hypertension, 18% smoking, and 12% diabetes mellitus. After 6 weeks, statistically significant blood pressure changes were observed (systolic-16.0 mmHg, diastolic-6.0 mmHg) without significant changes in FMD. In subset analyses, FMD increased more among abacavir-treated, PI-treated, and non-smoking participants.
  
  
  CONCLUSIONS
  No significant FMD changes were observed after 6 weeks of telmisartan therapy; however, abacavir- and PI-treated participants and non-smokers showed greater FMD increases. Additional studies are needed to explore the effects of telmisartan on endothelial function among HIV-infected individuals with traditional CVD and/or ART-specific risk factors.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.forename: Sophie
authors.initials: S
authors.lastname: Seang
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kelesidis
authors.forename: Diana H
authors.initials: DH
authors.lastname: Liao
authors.forename: Howard N
authors.initials: HN
authors.lastname: Hodis
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D001565:Benzoates / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D015224:Dideoxynucleosides / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D000077333:Telmisartan; D000099227:Abacavir
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D019380:Anti-HIV Agents; D001562:Benzimidazoles; D001565:Benzoates; D015224:Dideoxynucleosides; D000077333:Telmisartan; D000099227:Abacavir
keywords: Cardiovascular risk; Endothelial function,; HIV,