ANTI-INFLAMMATORY EFFECTS OF TELMISARTAN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND HYPERTENSION
Abstract
Objective: To determine the effect of angiotensin receptor blocker (Telmisartan) on C reactive protein reduction in patients with type 2 diabetes mellitus and hypertension.
Study Design: Cross-sectional descriptive study.
Place and Duration of Study: Department of Medicine of Khyber Teaching Hospital Peshawar.
Methodology: After approval from the hospital ethical and research committee the study was conducted and it included 112 patients recruited through nonprobability consecutive sampling. A written and informed consent was taken and patients were subjected to a detailed history and clinical examination after which the baseline CRP was measured. Then they were started on Telmisartan at a dose of 40mg per day. Patients were followed up at the 6th week of starting treatment and the level of CRP was measured again. Data were analyzed using SPSS Version 16.
Results: Out of the 112 patients included in the study 57% were females and 43% were males. The mean age was 49.46 9(SD±10). The average CRP level before the commencement of the treatment was 5.98 mg/dl (SD±1.8) while levels after 6 weeks of treatment the level fell to an average of 4.5mg/dl (SD±2). In 67% of the patients, the drug was found to be efficacious while 33% of the drug was not effective. Conclusion: Telmisartan is efficacious in reducing the C-reactive protein levels in patients with type2 diabetes mellitus and hypertension.
Downloads
References
Peter M. Nilsson. Hypertension and Diabetes: Should We Treat Early Surrogates? What are the cons? Diabetes Care. Nov 2009; 32: 290–293
Ai M. Atherosclerosis and hypertension. Nihon Rinsho. 2012; 70:840-5.
Sertic J, Skoric B, Lovric J, Bozina T, Reiner Z. Does Lp-PLA2 determination help predict atherosclerosis and cardiocerebrovascular disease? Acta Med Croatica. 2010 ;64:237-45.
Yokota T, Osanai T, Hanada K, Kushibiki M, Abe N, Oikawa K et al. Effects of telmisartan on markers of ventricular remodeling in patients with acute myocardial infarction: comparison with enalapril. Heart Vessels. 2010; 25:460-8.
Ozaki N, Nomura Y, Sobajima H, Kondo K, Oiso Y. Comparison of the effects of three angiotensin II receptor type 1 blockers on metabolic parameters in hypertensive patients with type 2 diabetes mellitus. Eur J Intern Med. 2010;21:236-9.
Rizos CV, Milionis HJ, Kostapanos MS, Florentin M, Kostara CE, Elisaf MS et al. Effects of rosuvastatin combined with olmesartan, irbesartan, or telmisartan on indices of glucose metabolism in Greek adults with impaired fasting glucose, hypertension, and mixed hyperlipidemia: a 24-week, randomized, open-label, prospective study. Clin Ther. 2010 ;32:492-505.
Prasad K. C-reactive protein (CRP)-lowering agents. Cardiovasc Drug Rev. 2006;24:33-50.
Matchar DB, McCrory DC, Orlando LA. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med 2008; 148:16.
Flack JM. Management of high blood pressure in Blacks: an update of the international society on Hypertension in blacks consensus treatment. Hypertension. 2010:56:780-800.
Nickenig G, Harrison DG. The AT(1)-type angiotensin receptor in oxidative stress and atherogenesis: Part II: AT(1) receptor regulation. Circulation 2002; 105:530.
Shaghayegh Haghjooy Javanmard, Mehdi Nematbakhsh, Azam Feghhi, and Nasim Dana. Hyperinsulinemia may have a protective role in the early stages of atherosclerosis in rabbit model of hypercholesterolemia. Journal of Diabetes & Metabolic Disorders.2012; 11:15
Charles Agyemang, Juliet Addo,Raj Bhopal, Ama de Graft Aikins, and Karien Stronks. Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review. Globalization and Health. 2009; 5:7
R Preston Mason,1,2 Robert F Jacob,2 Ruslan Kubant,3 Adam Jacoby,3 Febee Louka,3 J Jose Corbalan, et al. Effects of angiotensin receptor blockers on endothelial nitric oxide release: the role of eNOS variants. Br J Clin Pharmacol. 2012; 74: 141–146.
Danielson E, Rifai N, for the Val-MARC Investigators Valsartan, blood pressure reduction, and C-reactive protein: primary report of the Val-MARC trial. Hypertension. 2006; 48:73–79.
Koulouris S, Symeonides P, Triantafyllou K. Comparison of the effects of ramipril versus Telmisartan in reducing serum levels of high-sensitivity C-reactive protein and oxidized low-density lipoprotein cholesterol in patients with type 2 diabetes mellitus. Am J Cardiol. 2005;95:1386–1388
Toba H, Wang J, Ohigashi M, Kobara M, Nakata T. Telmisartan protects against vascular dysfunction with peroxisome proliferator-activated receptor-γ activation in hypertensive 5/6 nephrectomized rats. Pharmacology. 2013; 92:265-75.
Goyal SN, Bharti S, Bhatia J, Nag TC, Ray R, Arya DS. Telmisartan, a dual ARB/partial PPAR-γ agonist, protects the myocardium from ischaemic reperfusion injury in experimental diabetes. Diabetes Obes Metab. 2011;13:533-41
Omote Y, Deguchi K, Kurata T, Yamashita T, Sato K, Hishikawa N, Abe K. Telmisartan Promotes Potential Glucose Homeostasis in Stroke-Resistant Spontaneously Hypertensive Rats via Peroxisome Proliferator-Activated Receptor γ Activation. Curr Neurovasc Res. 2015; Epub ahead of print.
Burnier M . Telmisartan: a different angiotensin II receptor blocker protecting a different population? J Int Med Res. 2009; 37:1662-79.
Galle J, Schwedhelm E, Pinnetti S, Böger RH, Wanner C. Antiproteinuric effects of angiotensin receptor blockers: telmisartan versus valsartan in hypertensive patients with type 2 diabetes mellitus and overt nephropathy. Nephrol Dial Transplant. 2008; 23:3174-83.
Prasad Bichu, Ravi Nistala, Asma Khan, James R Sowers, and Adam Whaley-Connell. Angiotensin receptor blockers for the reduction of proteinuria in diabetic patients with overt nephropathy: results from the AMADEO study. Vasc Health Risk Manag. 2009; 5: 129–140.
Hisato Takagi, Masao Niwa, Yusuke Mizuno, Shin-nosuke Goto, Takuya Umemoto. A meta-analysis of randomized trials of telmisartan vs. valsartan therapy for blood pressure reduction. Hypertension Research. 36, 627-633.