Telmisartan in the Treatment of Hypertension in Patients With Chronic Renal Insufficiency

Abstract

The primary aim of this study was evaluation of the efficacy of telmisartan (angiotensin II receptor blocker- AT(1) blocker) on blood pressure in 10 patients with renal impairment in moderate or advanced stages of renal insufficiency and not dependent on haemodialysis. Its effect on proteinuria, renal function (represented by serum urea, creatinine, glomerular filtration), evaluation of overall therapy compliance in comparison with a previously prescribed angiotensin converting enzyme inhibitors (ACEI) were secondary aims. Considering the presence of left ventricle hypertrophy in all patients as a marker of hypertensive cardiopathy, the effect of telmisartan therapy on non-invasive cardiovascular parameters (ECG, echocardiography, and assessment of heart rate variability-HRV) was also evaluated. The study group involved 10 hypertensive patients (6 women, 4 men) with diabetic and non-diabetic renal impairment, proteinuria above 1 g/24 hours, hypertensive cardiopathy and intolerance of ACEI (cough). Telmisartan was added to their long-term antihypertensive combination therapy in a dose of 40 mg for the first 14 days, after which the dose increased to the maximal of 80 mg. The average initial daytime systolic blood pressure (SBP) was 149 +/- 19.7 mm Hg, average night-time SBP 145 +/- 23.0 mm Hg, average initial daytime diastolic BP (DBP) 90.6 +/- 2.5 mm Hg, night-time DBP 88.9 +/- 13.5 mm Hg. Average initial serum creatinine was 207.2 +/- 48.5 micromol/l, urea 15.1 +/- 4.4 mmol/l, GF 0.5 +/- 0.1 ml/s. Echocardiography revealed left ventricular (LV) hypertrophy with well preserved systolic and moderately impaired diastolic LV function. Also the HRV assessment revealed impaired neurovegetative (e.g. sympathovagal) balance. After 1 year of combination therapy with telmisartan, there was a clearly significant reduction in both SBP and DBP in both day and night-time (SBP daytime 149.6 vs.116.6 mm Hg, night-time 145.8 vs. 129.5 mm Hg; DBP daytime 90.6 vs. 83.5 mm Hg, night-time 88.9 vs. 79.3 mm Hg) and proteinuria (2.37 vs. 1.27 g/24 hour, p < 0.05). There were no significant changes in serum creatinine, urea values, and LV functions. On the other hand, further progression of the sympathovagal balance impairment was noted (continuing reduction of HRV in 9 from 10 patients), which can be described as the priority finding. The total compliance of telmisartan therapy was very good and without adverse clinical side effects. In conclusion - telmisartan reduces blood pressure and proteinuria safely and effectively in patients with various types of nephropathy in moderate or advanced stages of renal insufficiency.

Treatment of hypertension and diabetes mellitus in patients with chronic kidney disease: a review

“…The patient population also saw a significant reduction in proteinuria [14] . Similar results were found in a trial conducted by Weinbergov á et al that investigated the use of telmisartan in 10 hypertensive patients with diabetic and non-diabetic renal impairment, proteinuria > 1 g/24 h, hypertensive cardiopathy and an intolerance of ACE-I (cough) [15] . After 1 year of treatment with telmisartan, a significant reduction in SBP, DBP and proteinuria was also seen in this study [15] .…”

“…Similar results were found in a trial conducted by Weinbergov á et al that investigated the use of telmisartan in 10 hypertensive patients with diabetic and non-diabetic renal impairment, proteinuria > 1 g/24 h, hypertensive cardiopathy and an intolerance of ACE-I (cough) [15] . After 1 year of treatment with telmisartan, a significant reduction in SBP, DBP and proteinuria was also seen in this study [15] . The IDNT (Irbesartan Diabetic Nephropathy Trial) also showed that an ARB can prove effective in decreasing the progression of nephropathy due to Type 2 diabetes [16] .…”

Effects of telmisartan and enalapril on renoprotection in patients with mild to moderate chronic kidney disease

“…A decline in renal function is inevitable in patients with CKD, and whereas ARBs can attenuate such decline, it has been thought that they cannot actually reverse the damage and improve renal function in general. However, some investigators reported that 24‐h Ccr and eGFR were increased slightly by telmisartan treatment [22,34]. We reported previously [17] that 24‐h Ccr increased significantly ( P ≤ 0·01 vs. baseline values) in CKD patients after 6 months of telmisartan treatment.…”

Angiotensin II receptor antagonist reduces urinary liver-type fatty acid-binding protein levels in patients with diabetic nephropathy and chronic renal failure

“…Unique renoprotective properties of angiotensin II receptor antagonist, which are independent of blood pressure lowering but related to decreased oxidative stress and correction of chronic hypoxia, have been reported [5]. Telmisartan, a highly selective angiotensin II type I receptor antagonist, reduces blood pressure and proteinuria effectively and safely in patients with moderate or advanced-stage renal insufficiency due to various types of nephropathy [6]. Long-term administration of high doses of telmisartan seems to improve the efficacy of the drug to decrease proteinuria and slow progression to end-stage renal failure in nondiabetic hypertensive renal disease [7].…”