Telmisartan's effect on blood pressure in type 2 diabetes patients with and without complications
In people with type 2 diabetes, cardiovascular disease (CVD) is the leading cause of morbidity. Hypertension (HTN) frequently coexists with diabetes, increasing the risk of end-organ damage significantly. Blockers of the RAAS, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), have become a mainstay in the treatment of patients with diabetes plus hypertension. Telmisartan is the only ARB indicated for the treatment of atherothrombotic CVD (history of coronary heart disease, stroke, or peripheral arterial disease) or types 2 diabetes mellitus (T2DM) with confirmed target organ damage, therefore, reduction in the cardiovascular risk and morbidity. Trials of telmisartan have also been shown to reduce the progression of renal disease in individuals with diabetes and varying degrees of nephropathy, an effect that appears to be at least partly independent of a reduction in blood pressure. The present review article is intended to give comprehensive information about the effect of telmisartan on blood pressure in type 2 diabetes patients with and without complications.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration (2002). Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 360, 1903–1913.
. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL (2000). Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med, 342, 905–912.
. Ehud Grossman1 and Franz H. Messerli (2011). Management of Blood Pressure in Patients with Diabetes. American Journal of Hypertension, 24(8), 863-875.
. IDF Diabetes Atlas. 10th ed. (2021). International Diabetes Federation. Available from: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. [Last accessed on 2022 Jan 19].
. Gadge P, Gadge R, Paralkar N, Jain P, Tanna V (2018). Effect of telmisartan on blood pressure in patients of type 2 diabetes with or without complications. Perspect Clin Res, 9, 155-60.
. Lim HS, Lip GY (2004). Arterial stiffness in diabetes and hypertension. J Hum Hypertens, 18, 467-8.
. Brown MJ, Castaigne A, de Leeuw PW, Mancia G, Palmer CR, Rosenthal T, Ruilope LM (2000). Influence of diabetes and type of hypertension on response to antihypertensive treatment. Hypertension, 35, 1038–1042.
. Ozawa M, Tamura K, Iwatsubo K, Matsushita K, Sakai M, Tsurumi-Ikeya Y, Azuma K, Shigenaga A, Okano Y, Masuda S, Wakui H, Ishigami T, Umemura S (2008). Ambulatory blood pressure variability is increased in diabetic hypertensives. Clin Exp Hypertens, 30, 213–224.
. Parati G, Bilo G, Ochoa JE (2011). Benefits of tight blood pressure control in diabetic patients with hypertension: Importance of early and sustained implementation of effective treatment strategies. Diabetes Care, 34 (2), S297-303.
. Ferrario CM, Strawn WB (2006). Role of the renin-angiotensin-aldosterone system and proinflammatory mediators in cardiovascular disease. Am J Cardiol, 98, 121–128.
. American Diabetes Association (2021). 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes–2021. Diabetes Care, 44(1), S125–50. https://doi.org/10.2337/dc21-S010 PMID: 33298421.
. Wago T, Yoshimoto T, Akaza I, Tsuchiya K, Izumiyama H, Doi M, Hirata Y (2010). Improvement of endothelial function in patients with hypertension and type 2 diabetes after treatment with telmisartan. Hypertension Research, 33, 796–801.
. Benson SC, Pershadsingh HA, Ho CI, Chittiboyina A, Desai P, Pravenec M, Qi N, Wang J, Avery MA, Kurtz TW (2004). Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity. Hypertension, 43, 993–1002.
. Cao Z, Cooper ME (2012). Efficacy of renin-angiotensin system (RAS) blockers on cardiovascular and renal outcomes in patients with type 2 diabetes. Acta Diabetol, 49, 243–254.
. Dzau VJ, Antman EM, Black HR, Hayes DL, Manson JE, Plutzky J, Popma JJ, Stevenson W (2006). The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation, 114, 2850–2870.
. Morawietz H (2006). Endothelial protection, AT1 blockade and cholesterol-dependent oxidative stress: the EPAS trial. Circulation, 114, 1S–296S.
. Chambers S (2008). Telmisartan: an effective antihypertensive for 24-hour blood pressure control. Drugs Context, 4, 1–14.
. Ayza MA, Zewdie KA, Tesfaye BA, Gebrekirstos ST, Berhe DF (2020). Anti-Diabetic Effect of Telmisartan Through its Partial PPARγ-Agonistic Activity. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 3627–3635.
. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C, for the ONTARGET Investigators (2008). Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med, 358,1547–155.
. Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, for the ONTARGET Investigators (2008). Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet, 372, 547–553.
. Yusuf S, Teo K, Anderson C, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, for the TRANSCEND Investigators (2008). Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet, 27(372), 1174–1183.
. Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y, Kawamori R, Takeuchi M, Katayama S, INNOVATION. Study Group (2007). Prevention of transition from incipient to overt nephropathy with telmisartan in patients with type 2 diabetes. Diabetes Care, 30, 1577–1578.
. Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y, Ryuzo Kawamori, Masahiro Takeuchi, Shigehiro Katayama, INNOVATION Study Group (2008). Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. Hypertens Res, 31(4), 657–664.
. Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, Mustonen J, Diabetics Exposed to Telmisartan, Enalapril Study Group (2004). Angiotensin-receptor blockade versus converting enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med, 351, 1952–1961.
. Barnett AH (2005). Preventing renal complications in diabetic patients: the diabetics exposed to telmisartan and enalapril (DETAIL) study. Acta Diabetol, 42(Suppl 1), S42–S49.
. Bakris G, Burgess E, Weir M, Davidai G, Koval S, AMADEO TM Study Investigators (2008). Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int, 74, 364–369.
. Vitale C, Mercuro G, Castiglioni C, Cornoldi A, Tulli A, Fini M, Volterrani M, Rosano GMC (2005). Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Cardiovasc Diabetol., 4(1), 6. doi:10.1186/1475-2840-4-6.
. Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM (2007). Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes. Diabetes Care, 30:1351-6.
. Galle J, Schwedhelm E, Pinnetti S, Böger RH, Wanner C, VIVALDI investigators (2008). Antiproteinuric effects of angiotensin receptor blockers: Telmisartan versus valsartan in hypertensive patients with type 2 diabetes mellitus and overt nephropathy. Nephrol Dial Transplant, 23:3174-83.
. Sasaki T, Noda Y, Yasuoka Y, Irino H, Abe H, Adachi H, Hattori S, Kitada H, Morisawa D, Miyatake K (2008). Comparison of the effects of telmisartan and olmesartan on home blood pressure, glucose, and lipid profiles in patients with hypertension, chronic heart failure, and metabolic syndrome. Hypertens Res, 31, 921-9.
. Mori H, Okada Y, Arao T, Nishida K, Tanaka Y (2012). Telmisartan at 80mg/day increases high-molecular-weight adiponectin levels and improves insulin resistance in diabetic patients. Adv Ther, 29, 635-44.