Comparative Effects of Telmisartan and Valsartan on Insulin Resistance in Hypertensive Patients with Metabolic Syndrome

Ichikawa, Yoshihiko

doi:10.2169/internalmedicine.46.7173

Cited by 54 publications

(43 citation statements)

References 21 publications

(10 reference statements)

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“…28 Our study builds upon the results of smaller trials involving patients with diabetes in which telmisartan was associated with significantly greater reductions in serum lipid levels, plasma glucose concentration, glycated hemoglobin levels and markers of insulin resistance relative to other angiotensin-receptor blockers. [9][10][11][12][13] In addition, we saw a reduced risk of our primary outcome among patients receiving valsartan. Although this effect was attenuated after adjusting for dose, some evidence suggests that valsartan may impart cardioprotective effects in patients with diabetes unrelated to dose or to the drug's efficacy as an antihypertensive agent.…”

Section: Discussionmentioning

confidence: 84%

Comparative effectiveness of angiotensin-receptor blockers for preventing macrovascular disease in patients with diabetes: a population-based cohort study

Antoniou

Camacho

Yao

et al. 2013

CMAJ

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Section: Discussionmentioning

confidence: 84%

Comparative effectiveness of angiotensin-receptor blockers for preventing macrovascular disease in patients with diabetes: a population-based cohort study

Antoniou

Camacho

Yao

et al. 2013

CMAJ

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“…The major strength of our study is that, from our knowledge, it is the first human blinded trial evaluating the effects of telmisartan and valsartan in steatohepatitis that uses paired liver biopsies simultaneously with cytolysis and IR assessment. Interestingly, although not pointing on steatohepatitis, a recent study by Ichikawa [27] demonstrated that in hypertensive patients with MS, receiving 20 mg telmisartan daily for 4 wk, resulted in a reduction of HOMA-R by 16%, while 40 mg valsartan/day did not show significant results on this parameter. There are differences between this study and our trial, including different dosage for valsartan (higher doses in our study), longer period of survey (20 mo vs 4 mo), younger study population (49 years vs 65 years), higher values of HOMA-IR (7.7 units vs 3 units), use of Japanese criteria for MS and permission for concomitant medication, but in all, our results confirm the insulin-sensitizing effect of telmisartan.…”

Section: Discussionmentioning

confidence: 90%

Angiotensin-receptor blockers as therapy for mild-to-moderate hypertension-associated non-alcoholic steatohepatitis

Georgescu¹,

Ionescu²,

Niculescu³

et al. 2009

WJG

159

127

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AIM:To evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis (NASH) score (NAS) using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo. METHODS:All patients met the NCEP-ATP Ⅲ criteria for metabolic syndrome. Histology confirmed steatohepatitis, defined as a NAS greater than five up to 3 wk prior inclusion, using the current criteria. Patients with viral hepatitis, chronic alcohol intake, drug abuse or other significant immune or metabolic hepatic pathology were excluded. Subjects were randomly assigned either to the valsartan (V) group (standard dose 80 mg o.d., n = 26), or to the telmisartan (T) group (standard dose 20 mg o.d., n = 28). Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion (visit 1) and end of treatment (EOT) were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides (TG) and total cholesterol (TC) were evaluated at inclusion and every 4 mo until EOT (visit 6). RESULTS:At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION:Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.

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“…It has been recognized that increased physical activity will improve insulin sensitivity [31]. For pharmacological intervention, metformin and insulin sensitizers for type 2 diabetes treatment [32] or antihypertensive and lipid lowering drugs can also improve insulin sensitivity [33].…”

Section: % Confidence Interval Pmentioning

confidence: 99%

Insulin resistance predicts the risk for recurrent coronary events in post-infarction patients

et al. 2015

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(HR 1.5; p = 0.038). The plasma level of plasminogen activator inhibitor-1 was associated with higher risk for recurrent coronary events in patients with insulin resistance (HR 1.79; p = 0.03, interaction p = 0.018). Conclusions: In conclusion, insulin resistance predicts recurrence of coronary events in post--infarction population. HOMA2-IR is better than BMI in stratifying risk of recurrent coronary events. (Cardiol J 2015; 22, 5: 519-526)

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Comparative Effects of Telmisartan and Valsartan on Insulin Resistance in Hypertensive Patients with Metabolic Syndrome

Cited by 54 publications

References 21 publications

Comparative effectiveness of angiotensin-receptor blockers for preventing macrovascular disease in patients with diabetes: a population-based cohort study

Comparative effectiveness of angiotensin-receptor blockers for preventing macrovascular disease in patients with diabetes: a population-based cohort study

Angiotensin-receptor blockers as therapy for mild-to-moderate hypertension-associated non-alcoholic steatohepatitis

Insulin resistance predicts the risk for recurrent coronary events in post-infarction patients

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