Abstract
It is known that the angiotensin receptor blockers (ARBs) have organ protective effects in patients with heart failure or renal impairment. Several studies have revealed that the ARB telmisartan has an organ protective effect, but there have been few studies directly comparing the effects of telmisartan and calcium antagonists, since most clinical studies on telmisartan have been conducted in treated patients or patients on combination therapy. The present study was conducted to compare the renal and vascular protective effects of telmisartan monotherapy and calcium antagonist monotherapy in untreated hypertensive patients. Forty-three patients with untreated essential hypertension were randomized to receive amlodipine (n=22) or telmisartan (n=21), which were respectively administered at doses of 5 mg and 40 mg once daily in the morning for 24 weeks. The patients were examined before and after treatment to assess changes of renal function, flow-mediated dilation (a parameter of vascular endothelial function), and brachial-ankle pulse wave velocity (baPWV; a parameter of arteriosclerosis). Before treatment, there were no significant differences in these parameters between groups. The decreases of urinary albumin excretion and baPWV, and the increase of flow-mediated dilation were significantly greater in the telmisartan group than the amlodipine group, while the antihypertensive effects were not significantly different between the two groups. In conclusion, these results suggest that telmisartan is more effective at protecting renal function and vascular endothelial function, and at improving arteriosclerosis than the calcium channel blocker in patients with essential hypertension.
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Suzuki H, Kanno Y, Efficacy of Candesartan on Outcome in Saitama Trial (E-COST) Group: Effects of candesartan on cardiovascular outcomes in Japanese hypertensive patients. Hypertens Res 2005; 28: 307–314.
Morgan T : Renin, angiotensin, sodium and organ damage. Hypertens Res 2003; 26: 349–354.
White WB, Lacourciere Y, Davidai G : Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure: impact on the early morning period. Am J Hypertens 2004; 17: 347–353.
Corretti MC, Anderson TJ, Benjamin EJ, et al: Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilatation of the brachial artery. J Am Coll Cardiol 2002; 39: 257–265.
Motobe K, Tomiyama H, Koji Y, et al: Cut-off value of the ankle-brachial pressure index at which the accuracy of brachial-ankle pulse wave velocity measurement is diminished. Circ J 2005; 69: 55–60.
Lacourciere Y, Lenis J, Orchard R, et al: A comparison of the efficacies and duration of action of the angiotensin II receptor blockers telmisartan and amlodipine. Blood Press Monit 1998; 3: 295–302.
Brenner BM, Cooper ME, de Zeeuw D, et al, RENAAL Study Investigators : Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–869.
Iino Y, Hayashi M, Kawamura T, et al, Japanese Losartan Therapy Intended for the Global Renal Protection in Hypertensive Patients (JLIGHT) Study Investigators : Renoprotective effect of losartan in comparison to amlodipine in patients with chronic kidney disease and hypertension—a report of the Japanese Losartan Therapy Intended for the Global Renal Protection in Hypertensive Patients (JLIGHT) study. Hypertens Res 2004; 27: 21–30.
Vanhoutte PM, Mombouli JV : Vascular endothelium: vasoactive mediators. Prog Cardiovasc Dis 1996; 39: 229–238.
Luscher TF, Barton M : Biology of the endothelium. Clin Cardiol 1997; 20 ( 11 Suppl 2): II-3–II-10.
Clowes AW, Reidy MA, Clowes MM : Kinetics of cellular proliferation after arterial injury. I. Smooth muscle growth in the absence of endothelium. Lab Invest 1983; 49: 327–333.
Cheetham C, O'Driscoll G, Stanton K, et al: Losartan, an angiotensin type I receptor antagonist, improves conduit vessel endothelial function in type II diabetes. Clin Sci (Lond) 2001; 100: 13–17.
Higashi Y, Sasaki S, Nakagawa K, et al: Effect of the angiotensin-converting enzyme inhibitor imidapril on reactive hyperemia in patients with essential hypertension: relationship between treatment periods and resistance artery endothelial function. J Am Coll Cardiol 2001; 37: 863–870.
Munakata M, Aihara A, Nunokawa T, et al: The influence of one-year treatment by angiotensin converting enzyme inhibitor on baroreflex sensitivity and flow-mediated vasodilation of the brachial artery in essential hypertension—comparison with calcium channel blockers. Clin Exp Hypertens 2003; 25: 169–181.
Anderson TJ, Elstein E, Haber H, et al: Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study). J Am Coll Cardiol 2000; 35: 60–66.
Uchida H, Nakamura Y, Kaihara M, et al: Practical efficacy of telmisartan for decreasing morning home blood pressure and pulse wave velocity in patients with mild-to-moderate hypertension. Hypertens Res 2004; 27: 545–550.
Munakata M, Nagasaki A, Nunokawa T, et al: Effects of valsartan and nifedipine coat-core on systemic arterial stiffness in hypertensive patients. Am J Hypertens 2004; 17: 1050–1055.
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Morimoto, S., Yano, Y., Maki, K. et al. Renal and Vascular Protective Effects of Telmisartan in Patients with Essential Hypertension. Hypertens Res 29, 567–572 (2006). https://doi.org/10.1291/hypres.29.567
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DOI: https://doi.org/10.1291/hypres.29.567
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