Comparison of Effects of Olmesartan and Telmisartan on Blood Pressure and Metabolic Parameters in Japanese Early-Stage Type-2 Diabetics with Hypertension

Nakayama, Shiho; Watada, Hirotaka; Mita, Tomoya; Ikeda, Fuki; Shimizu, Tomoaki; Uchino, Hiroshi; Fujitani, Yoshio; Hirose, Takahisa; Kawamori, Ryuzo

doi:10.1291/hypres.31.7

Cited by 66 publications

(77 citation statements)

References 38 publications

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“…The present study demonstrated that olmesartan significantly reduced serum hsCRP levels as previously reported. 25,[45][46][47] However, the changes in hsCRP levels were not associated with those in FMD. As in the case of microalbuminuria, as RAS inhibition produces pleiotropic effects, there may not be a simple one-to-one correlation between serum hsCRP levels and endothelial function either.…”

Section: Discussionmentioning

confidence: 90%

Olmesartan improves endothelial function in hypertensive patients: link with extracellular superoxide dismutase

et al. 2011

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Endothelial dysfunction in essential hypertension is an independent predictor for future cardiovascular events. Although inhibition of the renin-angiotensin system (RAS) reportedly improves endothelial function through its effects on oxidative stress and inflammation, questions remain regarding the factors that are pivotal for improvement of endothelial function by RAS inhibition. We therefore performed a prospective, randomized crossover trial in which an angiotensin II type 1 receptor antagonist, olmesartan and calcium channel blocker, amlodipine, were compared in 31 essential hypertensive patients. Results showed that, although both treatments achieved comparable lowering of blood pressure (BP), olmesartan, but not amlodipine, significantly improved endothelial function as evaluated by flow-mediated vasodilation (FMD) in the brachial artery. Although no significant changes in diabetic and lipid parameters were observed with either drug, olmesartan slightly decreased estimated glomerular filtration rate, which, surprisingly, translated into decreased microalbuminuria. In a similar vein, olmesartan reduced serum C-reactive protein and increased urine antioxidant levels compared with baseline, and reduced urine 8-epi-prostaglandin F2a levels compared with both baseline and amlodipine. Finally, although overall changes in plasma extracellular superoxide dismutase (EC-SOD) levels were not modulated by either treatment, for olmesartan there was a positive correlation between changes in FMD and those in EC-SOD levels. In conclusion, olmesartan improved endothelial function in hypertensive patients independent of its BP-lowering effect, which was due, at least in part, to its antioxidative property. Therefore, olmesartan might provide a greater long-term benefit for hypertensive patients with impaired endothelial function than amlodipine.

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Section: Discussionmentioning

confidence: 90%

Olmesartan improves endothelial function in hypertensive patients: link with extracellular superoxide dismutase

et al. 2011

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“…[37][38][39] ARBs, particularly telmisartan and olmesartan, also exert antidiabetic effects through their regulation of insulin sensitivity and reduce not only urinary albumin excretion but also urinary 8-OHdG and L-FABP excretion. 40 Statins have been shown to ameliorate tubular and podocyte injury, preserve GFR and reduce proteinuria in renal disease. 41,42 In the present study, although all subjects were already treated with the maximal recommended dose of the ARB olmesartan, and there was no significant difference in the number of patients treated by statins at baseline between the two groups, further reduction in high-sensitivity CRP, urinary 8-OHdG and L-FABP levels was obtained.…”

Section: Discussionmentioning

confidence: 99%

Additive antioxidative effects of azelnidipine on angiotensin receptor blocker olmesartan treatment for type 2 diabetic patients with albuminuria

et al. 2011

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The present study aimed to determine whether either of two calcium channel blockers affected urinary albumin excretion or urinary levels of 8-hydroxy-2¢-deoxyguanosine (8-OHdG) and liver-type fatty acid-binding protein (L-FABP) in hypertensive diabetic patients with chronic kidney disease (CKD) who were already being treated with maximum doses of the angiotensin II receptor blocker olmesartan. We conducted an open-label, randomized, parallel-controlled study on type 2 diabetic patients with stable glycemic control who were receiving fixed doses of antidiabetic agents. The patients received either 8 mg per day azelnidipine, which was increased up to 16 mg per day (azelnidipine group; n¼34), or 2.5 mg per day amlodipine, which was increased up to 5 mg per day (amlodipine group; n¼33), over a 24-week period. Mean systolic and diastolic blood pressure decreased significantly in both groups, but there was no significant difference between the two groups at the end of the study. Serum creatinine levels and estimated glomerular filtration rate did not differ significantly between the two groups, whereas the urinary albumin/creatinine ratio and 8-OHdG and L-FABP levels decreased significantly in the azelnidipine group compared with the amlodipine group. Plasma aldosterone level was significantly decreased in the azelnidipine group, and its changes correlated significantly with those of urinary 8-OHdG and L-FABP. Our results suggest that the addition of azelnidipine to the maximal recommended dose of olmesartan was more effective in reducing albuminuria and oxidant stress in hypertensive diabetic patients with CKD than the addition of amlodipine. Hypertension Research (2011) 34, 935-941; doi:10.1038/hr.2011.67; published online 9 June 2011 Keywords: aldosterone; calcium channel blocker; chronic kidney disease; diabetic nephropathy; oxidant stress INTRODUCTIONThe importance of strict blood pressure (BP) control in patients with chronic kidney disease (CKD) was emphasized by the Japanese Society of Hypertension recommendations of a target BP of o130/ 80 mm Hg for hypertensive patients with CKD. This target is further reduced to o125/75 mm Hg for diabetic nephropathy patients whose urinary protein excretion is 41 g per day. 1 Reduction in proteinuria using suitable therapeutic interventions, similar to renin-angiotensin system (RAS) blockade an antihypertensive treatment regimen, is associated with a slower decline in renal function compared with other treatment groups with similar BPs. 2,3 RAS blockade with angiotensin-converting enzyme inhibitors or angiotensin II type-1 receptor blockers (ARBs) is currently considered the most effective pharmacological approach for renoprotection. These agents reduce proteinuria more effectively than other antihypertensive drugs, and therefore, RAS inhibitors should be titrated to maximal recommended doses. 1,4 However, it is difficult to control BP with mono-

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“…13 Such findings are inline with in vitro studies, which show that OM produces a strong blockade of the AT 1 receptor, with a high degree of insurmountable binding, slow dissociation and high affinity for the AT 1 receptor. 14 The clinical consequences of this robust inhibition of the AT 1 receptor appear as the sustained reductions in SBP and DBP over 24 h seen in the metaanalysis of Fabia et al 7 Direct clinical comparisons in which OM produced larger reductions in BP measured by ABPM than several other ARBs may also reflect stronger AT 1 receptor blockade [15][16][17] The 2009 re-appraisal of the ESH-ESC guidelines on hypertension management acknowledge that, in general, in up to 20% of patients with hypertension BP control cannot be achieved by a two-drug combination. 4 However, even treatment with an ARB with superior AT 1 receptor binding characteristics may not lead to high rates of BP goal achievement in a population that includes a high proportion of patients with severe hypertension.…”

Section: Discussionmentioning

confidence: 99%

Effects of high dose olmesartan medoxomil plus hydrochlorothiazide on blood pressure control in patients with grade 2 and grade 3 hypertension

et al. 2010

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Comparison of Effects of Olmesartan and Telmisartan on Blood Pressure and Metabolic Parameters in Japanese Early-Stage Type-2 Diabetics with Hypertension

Cited by 66 publications

References 38 publications

Olmesartan improves endothelial function in hypertensive patients: link with extracellular superoxide dismutase

Olmesartan improves endothelial function in hypertensive patients: link with extracellular superoxide dismutase

Additive antioxidative effects of azelnidipine on angiotensin receptor blocker olmesartan treatment for type 2 diabetic patients with albuminuria

Effects of high dose olmesartan medoxomil plus hydrochlorothiazide on blood pressure control in patients with grade 2 and grade 3 hypertension

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