Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy
ABSTRACT In patients with diabetic nephropathy, lowering blood pressure and reducing proteinuria by over 30% correlates with a slower progression to kidney failure. We compared two different angiotensin receptor-blockers in a double blind, prospective trial of 860 patients with type 2 diabetes whose blood pressure levels was over 130/80 mmHg or who were receiving antihypertensive medication(s) and who had a morning spot urinary protein to creatinine ratio of 700 or more. Patients were randomized to telmisartan (a highly lipophilic agent with a long half-life) or losartan (with low lipophilicity and short half-life). The primary endpoint was the difference in the urinary albumin to creatinine ratio between the groups at 52 weeks. The geometric coefficient of variation and the mean of the urinary albumin to creatinine ratio fell in both groups at 52 weeks but both were significantly greater for the telmisartan compared to the losartan cohort. Mean systolic blood pressure reductions were not significantly different between groups at trial end. We conclude that telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy, despite a similar reduction in blood pressure.
SourceAvailable from: James Dinicolantonio[Show abstract] [Hide abstract]
ABSTRACT: Angiotensin II (ATII), acting via Type I ATII receptors (AT1R), promotes vasoconstriction of vascular smooth muscle; hence, angiotensin antagonist drugs, i.e., angiotensin receptors blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors, are employed in the management of hypertension. However, AT1R stimulation also activates nicotinamide adenine dinucleotide phosphate oxidase complexes in a range of tissues, via joint stimulation of protein kinase C and Rac. Angiotensin antagonist drugs therefore function as “source antioxidants” preventing oxidative stress at its source by blocking superoxide production. This phenomenon may explain why these drugs have been found to convey a range of health benefits that are at least partially independent of their impact on blood pressure. These benefits appear to include: A reduction in risk for Type 2 diabetes; an improvement in endothelial function; reduced risk for vascular disorders including atrial fibrillation, left ventricular hypertrophy and aortic aneurysms; reduced mortality in, and a possible preventive impact on, chronic obstructive pulmonary disease; slowed progression of kidney disease; slowed progression of diabetic neuropathy and retinopathy; decreased risk for non-alcoholic fatty liver disease; neuroprotective effects which may aid prevention of Parkinson’s and Alzheimer’s diseases; and an inhibitory impact on induction and spread of prostate cancer. There is reason to suspect that each of these benefits is largely attributable to the source antioxidant activity of ARB and ACE inhibitors. In light of the versatility of the protection afforded by these drugs, and the low risk for side effects with ARB, consideration should be given to the possibility of using ARB as a preventive measure in the general population (excluding pregnant women), in non-hypertensives and hypertensives alike - perhaps as a component of a “polypill.” Moreover, the broadly favorable clinical experience with angiotensin antagonist drugs suggests that source antioxidants as a class may have far greater potential for preserving health than antioxidants which merely act as oxidant scavengers.03/2015; 4(1):1-16. DOI:10.5455/oams.180115.rv.015
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Aim: Recently, obesity patients have been diagnosed as metabolic syndrome. The aim of this study was to evaluate which angiotensin type 1 receptor blockers (ARBs), telmisartan or candesartan, is superior for the control of home blood pressure (BP) in the morning when the outpatient clinic BP was well controlled in the patients with metabolic syndrome. Methods: The patients with metabolic syndrome were enrolled. Home BP was monitored by using a telemedicine system. After a 2- to 4-week control period to establish baseline home BP values, these patients were randomly divided into telmisartan (20-80 mg) and candesartan (4-12 mg) groups. These end points were evaluated by using the telemedicine system during steady-state active therapy. A total of 356 patients attending 60 outpatient Japanese centers were recruited. Results: On a day of active therapy, telmisartan significantly lowered both systolic and diastolic home BP in the morning to a greater extent compared to candesartan. At the end of the study, reductions in systolic and diastolic home BP in the morning, in telmisartan group were significantly larger compared to the changes in the candesartan group (systolic; Tel: 12.0 ± 8.9 versus Can: 8.1 ± 17.1 mmHg, p = 0.0292, diastolic; Tel: 7.4 ± 6.1 versus Can: 3.7 ± 6.8 mmHg, p = 0.0053). Additionally in the telmisartan treated group, LDL-cholesterol showed significant reduction (p = 0.037), but candesartan did not. Conclusion: The present study by using the telemedicine system clearly demonstrated that telmisartan has a strong effect on reducing morning home BP, and a good effect on lipid metabolism in patients with metabolic syndrome.Clinical and Experimental Hypertension 01/2014; 36(7). DOI:10.3109/10641963.2013.863325 · 1.46 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Mitochondrial dysfunction plays an important role in cellular senescence and impaired function of vascular endothelium, resulted in cardiovascular diseases. Telmisartan is a unique angiotensin II type I receptor blocker that has been shown to prevent cardiovascular events in high risk patients. AMP-activated protein kinase (AMPK) plays a critical role in mitochondrial biogenesis and endothelial function. This study assessed whether telmisartan enhances mitochondrial function and alters cellular functions via AMPK in human coronary artery endothelial cells (HCAECs).Atherosclerosis 04/2015; 239(2). DOI:10.1016/j.atherosclerosis.2015.01.037 · 3.97 Impact Factor