Effect of Telmisartan on Cholesterol Levels in Patients with Hypertension - Saga Telmisartan Aggressive Research (STAR)

Abstract

Saga Telmisartan Aggressive Research (STAR) is a single-arm, prospective multi-center trial to evaluate the effectiveness of treatment with telmisartan in patients with hypertension. A total of 197 patients with a systolic blood pressure of > or =140 or a diastolic blood pressure of > or =90 mmHg were enrolled in this study, and were prescribed 20 to 80 mg/day of telmisartan for 6 months. In all patients, both systolic and diastolic blood pressures decreased (159+/-20 to 135+/-12 mmHg, p<0.0001, 87+/-12 to 75+/-8 mmHg, p<0.0001, respectively). In addition, total cholesterol (TC) levels decreased from 200+/-40 to 188+/-33 mg/dl (p<0.05). In patients with TC > or =220 mg/dl, the change was more striking (249+/-33 to 204+/-31 mg/dl, p<0.0001). Even in patients receiving statins, TC levels still were decreased (216+/-51 to 190+/-31 mg/dl, p<0.02). In addition, TC levels were also decreased even in patients receiving telmisartan in exchange for other ARBs with TC > or =220 mg/d. Triglyceride (TG) levels were decreased (270+/-199 to 175+/-74 mg/dl, p<0.005) in patients with TG levels > or =150 mg/dl. Fasting blood glucose (FBG) was decreased (158+/-68 to 138+/-60 mg/dl, p<0.05) in patients with FBG > or =110 mg/dl. These results suggest that telmisartan may have favorable effects on lipid and glucose metabolism, in addition to lowering blood pressure. The profound effect of telmisartan to lower cholesterol suggests a potential use in hypertensive patients with dyslipidemia.

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

“…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. 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.…”

Comparison of the Effects of Telmisartan and Olmesartan on Home Blood Pressure, Glocose, and Lipid Profiles in Patients with Hypertension, Chronic Heart Failure, and Metabolic Syndrome

“…These results suggest that the molecular mechanism underlying the favorable effects of telmisartan on lipid disorder may differ from those of statins, and that the lipid metabolism improvement is a unique effect of telmisartan not shared by other ARBs. These results were mostly in agreement with a recent report, which stated that severely altered baseline lipid parameters are necessary to see an improvement in lipid metabolism with telmisartan treatment (44). This mechanism of action of telmisartan remains unclear, but could perhaps be explained by the high lipophilicity of this agent as compared with other ARBs, including olmesartan (46), by PPAR-α-activating effects but not PPAR-γ-activating effects (13), or by unknown molecular effects to fat cells.…”

“…2A, B, and 3A). Previous studies indicated reduced TC, LDL cholesterol, and TG levels after treatment with telmisartan (37,43,44), while other studies noted no such findings (35,42,45). Although these reports were difficult to compare because the baseline lipid profiles of the subjects and telmisartan doses differed among the studies, the baseline TC, LDL cholesterol, and TG were higher in the former than in the latter reports.…”

Liver-Specific Peroxisome Proliferator–Activated Receptor α Target Gene Regulation by the Angiotensin Type 1 Receptor Blocker Telmisartan

“…When compared with ARBs that do not exert PPAR␥-activating properties, telmisartan not only improves insulin sensitivity but also induces beneficial actions on serum lipid levels such as a reduction of serum triglycerides. (5,10,11) PPARs are ligand-activated transcription factors belonging to the superfamily of nuclear receptors. PPAR␥ is abundantly expressed in adipose tissue and a major regulator of insulin and glucose metabolism (12).…”