Comparison of the effects of three angiotensin II receptor type 1 blockers on metabolic parameters in hypertensive patients with type 2 diabetes mellitus

May 25, 2010European journal of internal medicine

Comparison of three blood pressure medicines on metabolism in people with high blood pressure and type 2 diabetes

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Abstract

In a study of 308 hypertensive patients with type 2 diabetes, treatment with 40 mg telmisartan showed comparable effects to 8 mg candesartan and 80 mg valsartan on metabolic parameters.

Blood pressure significantly decreased in all treatment groups after 3 months.
Changes in metabolic markers, including fasting glucose and cholesterol levels, were similar across telmisartan, candesartan, and valsartan groups.
Telmisartan and candesartan showed a tendency to reduce urinary albumin excretion.
The findings suggest a neutral effect of telmisartan on metabolic dysfunction in this patient population.
The study may have lacked sufficient statistical power to detect differences in metabolic outcomes among the angiotensin II receptor blockers.

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OBJECTIVE: In a previous study involving 18 hypertensive patients with type 2 diabetes mellitus, we found that replacement of valsartan and candesartan by telmisartan significantly improved insulin sensitivity and significantly increased serum adiponectin levels in the patients. We investigated the effects of 3 angiotensin II type 1 receptor blockers (ARBs)-telmisartan, candesartan, and valsartan-on metabolic parameters in hypertensive patients with type 2 diabetes.

METHODS: A total of 308 hypertensive patients with diabetes were enrolled in our multicentre, randomized, open-label study. The patients received 40 mg telmisartan, 8 mg candesartan, or 80 mg valsartan for 3 months, and the data of 227 patients (telmisartan: n=74, candesartan: n=79, and valsartan: n=74) were analysed.

RESULTS: The systolic and diastolic blood pressures significantly decreased in all the groups at the end of the study; the decrease was comparable among the 3 groups. The changes in fasting plasma glucose, fasting insulin, glycated haemoglobin (HbA1c), total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, adiponectin, free fatty acids, high-sensitivity C-reactive protein (hs-CRP), and plasminogen activator inhibitor-1 (PAI-1) were comparable between the 3 groups. Telmisartan and candesartan administration tended to lower urinary albumin excretion.

CONCLUSIONS: Low dose telmisartan had a neutral effect on metabolic dysfunction in hypertensive patients with type 2 diabetes; the effect produced by 40 mg telmisartan was comparable with that of 8 mg candesartan and 80 mg valsartan. Failure to detect metabolic differences among the various ARB treatments could have been due to the low statistical power of the study design.

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Comparison of the effects of three angiotensin II receptor type 1 blockers on metabolic parameters in hypertensive patients with type 2 diabetes mellitus

Abstract

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