Comparison of the Effects of Valsartan and Felodipine on Plasma Leptin and Insulin Sensitivity in Hypertensive Obese Patients

Fogari, Roberto; Derosa, Giuseppe; Zoppi, Annalisa; Rinaldi, Andrea; Lazzari, Pierangelo; Fogari, Elena; Mugellini, Amedeo; Preti, Paola

doi:10.1291/hypres.28.209

Cited by 53 publications

(38 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, we demonstrated that this ARB has a favorable effect on plasma TG and TC in opposition to Ichikawa and other groups [28,29] , but in accordance with others [30][31][32][33][34] . As for valsartan, again in contrast with Ichikawa, but in accordance with larger studies [35,36] , we demonstrated that it also reduces IR, although it has no other effects on lipid profiles.…”

Section: Discussionsupporting

confidence: 90%

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

Georgescu¹,

Ionescu²,

Niculescu³

et al. 2009

WJG

160

127

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

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

Georgescu¹,

Ionescu²,

Niculescu³

et al. 2009

WJG

160

127

View full text Add to dashboard Cite

show abstract

“…28 Our results are consistent with more recent studies indicating that calcium channel blockers provide similar BP reductions to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in obese patients with hypertension. 21,26 However, the marked increase in the incidence of peripheral edema observed with amlodipine/HCTZ in the present study suggests that tolerability issues may limit the usefulness of calcium channel blockers in obesity-associated hypertension.…”

Section: Discussionmentioning

confidence: 56%

“…Early, small studies suggested that dihydropyridine calcium channel blockers were less effective for the treatment of obesity-associated hypertension. 25 Furthermore, they could further increase sympathetic nervous system activity 26,27 (a known factor in weight gain-associated BP elevation). 28 Our results are consistent with more recent studies indicating that calcium channel blockers provide similar BP reductions to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in obese patients with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Direct Renin Inhibition With Aliskiren in Obese Patients With Arterial Hypertension

et al. 2007

View full text Add to dashboard Cite

Abstract-Current guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend first-line treatment with a thiazide diuretic but do not provide specific guidance for obese patients. The renin system is activated in obesity-associated arterial hypertension. Therefore, we tested the hypothesis that the oral direct renin inhibitor aliskiren could provide additive blood pressure lowering in obese patients with hypertension (body mass index Ն30 kg/m 2 ; mean sitting diastolic blood pressure: 95 to 109 mm Hg) who had not responded to 4 weeks of treatment with hydrochlorothiazide (HCTZ) 25 mg. After a 2-to 4-week washout, 560 patients received single-blind HCTZ (25 mg) for 4 weeks; 489 nonresponders were randomly assigned to double-blind aliskiren (150 mg), irbesartan (150 mg), amlodipine (5 mg), or placebo for 4 weeks added to HCTZ (25 mg), followed by 8 weeks on double the initial doses of aliskiren, irbesartan, or amlodipine. After 8 weeks of double-blind treatment (4 weeks on the higher dose), aliskiren/HCTZ lowered blood pressure by 15.8/11.9 mm Hg, significantly more (PϽ0.0001) than placebo/HCTZ (8.6/7.9 mm Hg). Aliskiren/HCTZ provided blood pressure reductions similar to those with irbesartan/ HCTZ and amlodipine/HCTZ (15.4/11.3 and 13.6/10.3 mm Hg, respectively), with similar tolerability to placebo/ HCTZ. Adverse event rates were highest with amlodipine/HCTZ because of a higher incidence of peripheral edema (11.1% versus 0.8% to 1.6% in other groups). In conclusion, combination treatment with aliskiren is a highly effective and well-tolerated therapeutic option for obese patients with hypertension who fail to achieve blood pressure control with first-line thiazide diuretic treatment. Key Words: direct renin inhibitor Ⅲ Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 Ⅲ obesity Ⅲ renin-angiotensin system Ⅲ thiazide diuretic T he proportion of hypertensive patients who are obese has increased steadily in recent years. Given that 75% of obese patients have hypertension, but Ͻ20% have their blood pressure (BP) controlled to Ͻ140/90 mm Hg, 1 there is a clear need for new antihypertensive treatment options for this patient group. Yet, current guidelines do not provide specific guidance for the treatment of this patient population, 2 and data from larger clinical trials addressing the issue are lacking. This state of affairs is surprising, because the underlying pathophysiology differs between lean and obese patients with arterial hypertension. In particular, obesityassociated hypertension involves activation of the renin system, 3,4 volume expansion, and increased cardiac output 5-7 rather than systemic vasoconstriction. Combination of a low dose of a thiazide diuretic with a renin system inhibitor may, therefore, be a suitable treatment approach. 8 Aliskiren is the first in a new class of direct renin inhibitors. 9,10 Combination treatment with a renin system inhibitor is a theoretically attracti...

show abstract

“…However, leptin has also been reported to have depressor effects; that is, leptin was shown to function as a diuretic/ natriuretic factor (39) and to induce a release of nitric oxide that opposes the pressor action (25). Although many epidemiologic researchers had studied the association of leptin with blood pressure and the sympathetic nervous system, these results were not consistent (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(40)(41)(42)(43)(44)(45). Our results may partly explain this diversity of findings.…”

Section: Discussionmentioning

confidence: 68%

A Positive Association between Leptin and Blood Pressure of Normal Range in Japanese Men

et al. 2006

View full text Add to dashboard Cite

show abstract

Comparison of the Effects of Valsartan and Felodipine on Plasma Leptin and Insulin Sensitivity in Hypertensive Obese Patients

Cited by 53 publications

References 51 publications

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

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

Direct Renin Inhibition With Aliskiren in Obese Patients With Arterial Hypertension

A Positive Association between Leptin and Blood Pressure of Normal Range in Japanese Men

Contact Info

Product

Resources

About