Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy: Comparing telmisartan's and losartan's effects on proteinuria

Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Kidney International (Impact Factor: 8.52). 09/2008; 74(3):364-9. DOI: 10.1038/ki.2008.204
Source: PubMed

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.

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Available from: Ellen D Burgess, Jan 26, 2015
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    • "There is also emerging evidence that telmisartan, in contrast to losartan, reduces progression of carotid artery thickening as assessed by carotid intima-media thickening in patients receiving treatment with ARBs [Hasegawa et al. 2011]. Finally, as described above, telmisartan was superior to losartan in reducing proteinuria , a known surrogate for renal dysfunction in patients with high CV risk, within the AMADEO trial [Bakris et al. 2008]. "
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    • "Multiple regression analysis showed significant correlations between Ambulatory BP profile and therapy in CKD 238 Am J Cardiovasc Dis 2011;1(3):236-243 urinary protein excretion and baPWV, 24-h LF-to -HF ratio, nighttime systolic BP, and 24-h shortterm systolic BP variability. Although the results of AMADEO study showed that telmisartan was more effective than losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy at levels of office BP that were not different between the telmisartan and losartan treatment groups, the possible mechanisms involved in this difference in antiproteinuric effect were not elucidated [22]. The results of this study suggest that ARB, particularly telmisartan, is effective in reducing proteinuria in hypertensive patients with overt diabetic nephropathy, partly through inhibitory effects on ambulatory short-term BP variability and sympathetic nerve activity, in addition to its longer duration of action on nighttime BP reduction. "
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