BACKGROUND:Hypertensive patients with IGT have increased risk for cardiovascular disease and progression to diabetes mellitus. Clinical trials suggest that the ARB telmisartan uniquely possesses PPARγ agonistic properties and improves insulin resistance as well as vascular endothelial dysfunction. The aim of the present study was to compare vascular effects of telmisartan and losartan in relation to their metabolic and antihypertensive effects in hypertensive patients with IGT. MATERIALS AND METHODS:24 patients were randomised in a double-blind, prospective, cross-over trial. At baseline and after 12 weeks of either treatment an oGTT, and endothelial function testing was performed. RESULTS:Endothelial function improved significantly by telmisartan treatment but not by losartan treatment (FMD; T: 7.9 ± 0.7%, vs B: 6.4 ± 0.8, p<0.01; vs L: 6.4 ± 0.6, p<0.001) at almost identical antihypertensive effect of both agents. Insulin resistance assessed by HOMA (T: 2.20 ± 0.47 vs B: 3.04 ± 0.60, p<0.01; vs L: 3.38 ± 0.84, T vs L p<0.05) and ISI120 (T: 0.114 ± 0.003 vs B: 0.092 ± 0.002, p<0.001; vs L: 0.090 ± 0.006, T vs L p<0.01) improved significantly after telmisartan only, as did glucose tolerance (p<0.01). The improvement of the endothelial function observed, significantly depended on pretreatment insulin resistance but was independent of improvements of insulin resistance, blood pressure or glucose tolerance. CONCLUSION: In hypertensive patients with IGTtelmisartan compared to losartan improved endothelial function and insulin resistance independently, supporting the hypothesis that glucometabolic and vascular insulin resistance are differentially regulated.
RCT Entities:
BACKGROUND:Hypertensivepatients with IGT have increased risk for cardiovascular disease and progression to diabetes mellitus. Clinical trials suggest that the ARB telmisartan uniquely possesses PPARγ agonistic properties and improves insulin resistance as well as vascular endothelial dysfunction. The aim of the present study was to compare vascular effects of telmisartan and losartan in relation to their metabolic and antihypertensive effects in hypertensivepatients with IGT. MATERIALS AND METHODS: 24 patients were randomised in a double-blind, prospective, cross-over trial. At baseline and after 12 weeks of either treatment an oGTT, and endothelial function testing was performed. RESULTS: Endothelial function improved significantly by telmisartan treatment but not by losartan treatment (FMD; T: 7.9 ± 0.7%, vs B: 6.4 ± 0.8, p<0.01; vs L: 6.4 ± 0.6, p<0.001) at almost identical antihypertensive effect of both agents. Insulin resistance assessed by HOMA (T: 2.20 ± 0.47 vs B: 3.04 ± 0.60, p<0.01; vs L: 3.38 ± 0.84, T vs L p<0.05) and ISI120 (T: 0.114 ± 0.003 vs B: 0.092 ± 0.002, p<0.001; vs L: 0.090 ± 0.006, T vs L p<0.01) improved significantly after telmisartan only, as did glucose tolerance (p<0.01). The improvement of the endothelial function observed, significantly depended on pretreatment insulin resistance but was independent of improvements of insulin resistance, blood pressure or glucose tolerance. CONCLUSION: In hypertensivepatients with IGT telmisartan compared to losartan improved endothelial function and insulin resistance independently, supporting the hypothesis that glucometabolic and vascular insulin resistance are differentially regulated.
Authors: Jordan E Lake; Sophie Seang; Theodoros Kelesidis; Diana H Liao; Howard N Hodis; James H Stein; Judith S Currier Journal: HIV Clin Trials Date: 2015-09-11
Authors: Norbert J Tripolt; Sophie H Narath; Michaela Eder; Thomas R Pieber; Thomas C Wascher; Harald Sourij Journal: Cardiovasc Diabetol Date: 2014-05-23 Impact factor: 9.951