Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy

Bakris, George L.; Burgess, Ellen; Weir, Matthew R.; Davidai, Giora; Koval, Stephen

doi:10.1038/ki.2008.204

Cited by 152 publications

(141 citation statements)

References 24 publications

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“…24 In this study, a more beneficial effect of telmisartan in reducing urinary protein excretion than losartan was accompanied by a more potent inhibitory effect of telmisartan on short-term BP variability and by its better lowering effect on nighttime systolic BP. Impaired diurnal autonomic nervous rhythm and proteinuria are closely related to the blunted decline in nocturnal BP and the resultant increase in nighttime BP, which is mainly caused by the comparative increase in sympathetic nerve activity.…”

Section: Discussionmentioning

confidence: 74%

“…Furthermore, previous studies have reported that telmisartan has a long-term half-life with peroxisome proliferator-activated receptor-g-activating property and a recent AMADEO study showed that telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy. 23,24 Therefore, in this study, we examined the possible effects of ARB losartan and telmisartan on diurnal BP profile, including the ambulatory short-term BP variability in hypertensive type II diabetic patients with overt nephropathy.…”

Section: Introductionmentioning

confidence: 99%

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Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

et al. 2009

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Previous studies have shown increases in ambulatory short-term blood pressure (BP) variability to be related to cardiovascular disease. In this study, we examined whether the angiotensin II type 1 receptor blocker (ARB) would improve ambulatory shortterm BP variability in hypertensive patients with diabetic nephropathy. A total of 30 patients with type II diabetes, along with hypertension and overt nephropathy, were enrolled in this randomized, two-period, crossover trial of 12 weeks of treatment with losartan (50 mg daily) and telmisartan (40 mg daily). At baseline and at the end of each treatment period, 24-h ambulatory BP monitoring with power spectral analysis of heart rate and measurements of proteinuria, estimated glomerular filtration rate and brachial-ankle pulse wave velocity (baPWV) were performed. After 12 weeks of treatment, 24-h, daytime and nighttime shortterm BP variability, assessed on the basis of the coefficient of variation of ambulatory BP, was significantly decreased by telmisartan. Both losartan and telmisartan reduced urinary protein excretion and baPWV. However, compared with losartan, telmisartan significantly decreased urinary protein excretion, baPWV and low-frequency (LF)-to-high-frequency (HF) ratio, an index of sympathovagal balance. Multiple regression analysis showed significant correlations between urinary protein excretion and baPWV, 24-h LF-to-HF ratio, nighttime systolic BP and 24-h short-term systolic BP variability. These results suggest that ARB, particularly telmisartan, is effective in reducing proteinuria in hypertensive patients with overt diabetic nephropathy, partly through inhibitory effects on ambulatory short-term BP variability and sympathetic nerve activity, in addition to its longer duration of action on nighttime BP reduction.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

et al. 2009

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“…One such trial of 860 patients with type 2 diabetes, urinary protein ⁄ creatinine ratio (UACR) of 700, and hypertension found that telmisartan reduced UACR to a greater extent than losartan with no significant differences in BP after 52 weeks of therapy. 54 The authors speculated that this difference might be attributable to pharmacologic characteristics of the 2 drugs since telmisartan has a longer duration of action and is more lipophilic than losartan. left ventricular mass index has been complicated by differences in measurement techniques and criteria used in various clinical trials.…”

Section: Surrogate Markers Of CV Outcomes Proteinuriamentioning

confidence: 99%

Angiotensin Receptor Blockers: Pharmacology, Efficacy, and Safety

Taylor

Siragy

Nesbitt

2011

The Journal of Clinical Hypertension

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Key Points and Practical Recommendations• The angiotensin receptor blockers are highly effective antihypertensive agents that are also particularly well tolerated.• There are no major differences in efficacy or other clinical characteristics among older drugs in this class, although some of the newer agents may more effectively reduce blood pressure than older agents.• Major randomized clinical trials have demonstrated that angiotensin receptor blockers provide significant outcomes benefits in conditions such as diabetic nephropathy, chronic heart failure or heart failure following myocardial infarction, hypertension with left ventricular hypertrophy and in patients whose histories of previous events or complicated diabetes puts them at high cardiovascular risk.• In treating hypertension, angiotensin receptor blockers can be used as first-line therapy or added at later stages of treatment titration.• These drugs are very effective in combination with thiazide diuretics or calcium channel blockers and there are several single-pill, fixed-dose combinations of angiotensin receptor blockers with hydrochlorothiazide, amlodipine, or aliskiren. These combinations can be given as initial therapy (where appropriate) or later in the course of treatment. Three-drug combinations (angiotensin receptor blocker plus amlodipine plus hydrochlorothiazide and angiotensin receptor blocker plus aliskiren plus hydrochlorothiazide) are also available. J Clin Hypertens (Greenwich). 2011;13:677-686. Ó2011 Wiley Periodicals, Inc.The renin-angiotensin-aldosterone system (RAAS) plays an important role in protecting vertebrates against cardiovascular collapse due to hypotension and volume loss in the event of traumatic injury that involves blood loss. In certain humans, however, inappropriate or exaggerated activity of the RAAS contributes to the development of hypertension and the initiation of a molecular cascade in tissues with consequent injury to critical organs such as the brain, kidneys, heart, and blood vessels. 1-3 As understanding of the pathologic role of the RAAS in hypertensive vascular disease has unfolded during the past century, so has the interest in developing drugs that could interdict specific components of the RAAS. The first of the RAAS-blocking drugs to become commercially available were the aldosterone antagonists in the 1970s, followed by the angiotensin-converting enzyme (ACE) inhibitors in the 1980s and the angiotensin II receptor blockers (ARBs) in the 1990s. Unlike ACE inhibitors that inhibit the conversion of angiotensin I to II, ARBs bind to the angiotensin II AT 1 receptor, thereby inhibiting the cellular actions of angiotension II mediated by the receptor in which the tissue is located. During the past 20 years, studies in the laboratory and clinic have documented that ARBs, either alone or in combination with drugs of other classes, reduce blood pressure (BP) in hypertensive animals and humans; reduce rates of myocardial infarction (MI), stroke, and progression of renal impairment; and positively impact oth...

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“…In the AMADEO study, telmisartan was superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy despite a similar reduction in BP. 39 Masuda et al 40 reported that telmisartan reduced proteinuria and improved the ambulatory short-term BP variability in type 2 DM patients compared with losartan. However, Bahadir et al 41 reported that telmisartan and losartan had neutral effects on insulin resistance in hypertensive MetS patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of telmisartan and losartan on cardiovascular protection in Japanese hypertensive patients

et al. 2011

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The Telmisartan and Losartan Cardiac Evaluation Trial, a multicenter, prospective, randomized, open-labeled, blinded-endpoint trial, was designed to compare the effects of two angiotensin II receptor blockers (ARBs), telmisartan and losartan, on cardiovascular protection in Japanese patients with mild to moderate essential hypertension. We compared the effects of telmisartan and losartan on left ventricular (LV) hypertrophy, cardiac function, atherosclerosis of carotid arteries and surrogate markers related to the actions of peroxisome proliferator-activated receptor-c. A total of 58 patients were enrolled in the present trial and the follow-up period was 1 year. There were no significant differences in blood pressure (BP) levels between the telmisartan group and the losartan group throughout the trial. The percentage of the patients treated with ARB monotherapy was significantly higher in the telmisartan group compared with the losartan group. In addition, the progression of intima-media thickness of common carotid artery was significantly inhibited in the telmisartan group compared with the losartan group. Neither group experienced significant changes in cardiac function and LV mass index. There were no differences between the groups with respect to changes in surrogate markers such as serum adiponectin, creatinine, homeostasis model assessment index, plasminogen activator inhibitor-1 and high sensitivity C-reactive protein. Although BP levels were equal and well controlled in both groups, telmisartan showed more protective vascular effects than losartan.

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Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy

Cited by 152 publications

References 24 publications

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

Angiotensin Receptor Blockers: Pharmacology, Efficacy, and Safety

Effects of telmisartan and losartan on cardiovascular protection in Japanese hypertensive patients

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