Journal of Endocrinological Investigation

, Volume 29, Issue 11, pp 957–961

The effects of irbesartan and telmisartan on metabolic parameters and blood pressure in obese, insulin resistant, hypertensive patients

Original Articles

Abstract

Obesity, hypertension, dyslipidemia and glucose intolerance cluster in the insulin resistance syndrome. Angiotensin II receptor blockers (ARB) are able to reduce insulin resistance. Furthermore, among ARB, telmisartan displays the property of stimulating PPARγ. The aim of the study was to examine if and to what extent treatment with irbesartan and telmisartan induces variations in metabolic parameters in insulin resistant, hypertensive subjects. Forty-six non diabetic, obese, insulin-resistant, hypertensive patients took part in the study. They were divided into 2 groups. Group A (23) was submitted to irbesartan 150 mg/day, Group B (23) to telmisartan 80 mg/day for 6 months. Adiponectin, glucose, cholesterol, triglycerides, free fatty acids (FFA), steady-state plasma insulin and glucose (SSPG), 24-hBP were determined at the beginning and at the end of the study. Both irbesartan or telmisartan reduced blood pressure and ameliorated the insulin sensitivity, with increased adiponectin values; in Group B, the amelioration of metabolic parameters was greater than in Group A and the reduction of blood pressure was related with variation of adiponectin levels. Data obtained showed that the antihypertensive action of telmisartan and irbesartan is associated with the amelioration of the metabolic picture. The greater impact on the improvement of the metabolic profile showed by telmisartan and the inverse correlation between adiponectin levels and blood pressure may be partly due to the action as partial PPARγ agonist displayed by telmisartan.

Key-words

ARB adiponectin hypertension insulin resistance 

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References

  1. 1.
    Abbasi F, Chu JW, Lamendola C, et al. Discrimination between obesity and insulin resistance in the relationship with adiponectin. Diabetes 2004, 53: 585–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Motoshima H, Wu X, Sinha MK, et al. Differential regulation of adiponectin secrection from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone. J Clin Endocrinol Metab 2002, 87: 5662–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Lind L, Berne C, Lithell H. Prevalence of insulin resistance in essential hypertension. J Hypertens 1995, 13: 1457–62.PubMedGoogle Scholar
  4. 4.
    Yusuf S, Gerstein H, Hoogwerf B, et al. HOPE Study Investigators. Ramipril and the development of diabetes. JAMA 2001, 286: 1882–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Furuhashi M, Ura N, Higashiura K, et al. Blockade of the renin-angiotensin system increases adiponectin concentrations in patients with essential hypertension. Hypertension 2003, 42: 76–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Pershadsingh HA, Kurtz TW. Insulin-sensitizing effects of Telmisartan. Diabetes Care 2004, 27: 1015.PubMedCrossRefGoogle Scholar
  7. 7.
    Vitale C, Mercuro G, Castiglioni C, et al. Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Cardiovasc Diabetol 2005, 4: 6–13.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Benson C, Pershadsingh HA, Ho CI, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARγ-modulating activity. Hypertension 2004, 43: 993–1002.PubMedCrossRefGoogle Scholar
  9. 9.
    Adams M, Montague CT, Prins JB, et al. Activators of peroxisome proliferator-activated receptor have depot-specific effects on human preadipocyte differentiation. J Clin Invest 1997, 100: 3149–53.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Pei D, Jones CN, Bhargava R, Chen YD, Reaven GM. Evaluation of octreotide to assess insulin-mediated glucose disposal by the insulin suppression test. Diabetologia 1994, 37: 843–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Greenfield MS, Doberne L, Kraemer F, Tobey T, Reaven G. Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp. Diabetes 1981, 30: 387–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM. Relatioship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000, 23: 171–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Derosa G, Ragonesi PD, Mugellini A, Ciccarelli L, Fogari R. Effects of telmisartan compared with eprosartan on blood pressure control, glucose metabolism and lipid profile in hypertensive, type 2 diabetic patients: a randomized, double-blind, placebo-controlled 12-month study. Hypertens Res 2004, 27: 457–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Folli F, Saad MJ, Velloso L, et al. Crosstalk between insulin and angiotensin II signaling systems. Exp Clin Endocrinol Diabetes 1999, 107: 133–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Kodama J, Katayama S, Tanaka K, Itabashi A, Kawazu S, Ishii J. Effect of captopril on glucose concentration. Possible role of augmented postprandial forearm blood flow. Diabetes Care 1990, 13: 1109–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Higashiura K, Ura N, Takada T, et al. The effect of an angiotensin-converting enzyme inhibitor and an angiotensin II receptor antagonist on insulin resistance in fructose-fed rats. Am J Hypertens 2000, 13: 290–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Togashi N, Ura N, Higashiura K, Murakami H, Simamoto K. The contribution of skeletal muscle tumor necrosis factor-to insulin resistance and hypertension in fructose-fed rats. J Hypertens 2000, 18: 1605–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Sharma AM, Janke J, Gorzelniak K, Engeli S, Luft FC. Angiotensin blockade prevents type 2 diabetes by formation of fat cells. Hypertension 2002, 40: 609–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Bogan JS, Lodish HF. Two compatments for insulin-stimulated exocytosis in 3T3-L1 adipocytes defined by endogenous ACRP30 and GLUT4. J Cell Biol 1999, 146: 609–20.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Maeda N, Takahashi M, Funahashi T, et al. PPARγ ligands increase expression and plasma concentrations of adiponectin, an adipose-derived protein. Diabetes 2001, 50: 2094–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Rosen E, Sarraf P, Troy AE, et al. PPARγ is required for the differentiation of adipose tissue in vivo and in vitro. Mol Cell 1999, 4: 611–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Virtanen KA, Hallsten K, Parkkola R, et al. Differential effects of rosiglitazone and metformin on adipose tissue distribution and glucose uptake in type 2 diabetic subjects. Diabetes 2003, 52: 283–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Berg AH, Combs TP, Du X, Brownlee M, Scherer PE. The adipocyte-secreted protein Acrp30 enhances hepatic insulin action. Nat Med 2001, 7: 947–53.PubMedCrossRefGoogle Scholar
  24. 24.
    Berg AH, Combs TP, Scherer PE. ACRP30/adiponectin: an adipokine regulating glucose and lipid metabolism. Trends Endocrinol Metab 2002, 13: 84–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Raji A, Seely EW, Bekins SA, Williams GH, Simonson DC. Rosiglitazone improves insulin sensitivity and lowers blood pressure in hypertensive patients. Diabetes Care 2003, 26: 172–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Negro R, Mangieri T, Dazzi D, Pezzarossa A, Hassan H. Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients. Diabetes Res Clin Pract 2005, 70: 20–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Qayyum R, Adomaityte J. A meta-analysis of the effect of thiazolidinediones on blood pressure. J Clin Hypertens 2006, 8: 19–28.CrossRefGoogle Scholar
  28. 28.
    Verstraete M. Value and limitation of meta-analysis. Pathophysiol Haemost Thromb 2002, 32: 278–81.PubMedCrossRefGoogle Scholar
  29. 29.
    Tan KCB, Xu A, Chow WS, et al. Hypoadiponectinemia is associated with impaired endothelium-dependent vasodilation. J Clin Endocrinol Metab 2004, 89: 765–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Anderson TJ. Nitric oxide, atherosclerosis and the clinical relevance of endothelial dysfunction. Heart Fail Rev 2003, 8: 71–86.PubMedCrossRefGoogle Scholar
  31. 31.
    Okamoto Y, Arita Y, Nishida M, et al. An adipocyte-derived plasma protein, adiponectin, adheres to injured vascular walls. Horm Metab Res 2000, 32: 47–50.PubMedCrossRefGoogle Scholar
  32. 32.
    Chen H, Montagnani M, Funahashi T, Shimomura I, Quon MJ. Adiponectin stimulates production of nitric oxide in vascular endothelial cells. J Biol Chem 2003, 278: 45021–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Dandona P. Insulin resistance and endothelial dysfunction in atherosclerosis: implications and interventions. Diabetes Technol Ther 2002, 4: 809–15.PubMedCrossRefGoogle Scholar
  34. 34.
    Ouchi N, Kihara S, Funahashi T, et al. Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue. Circulation 2003, 107: 671–4.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  1. 1.Department of EndocrinologyAUSLLE/1 P.O. “V. Fazzi”LecceItaly
  2. 2.Department of EndocrinologyRIPAS HospitalBrunei
  3. 3.Department of EndocrinologyAUSL LE/1, P.O. “V. Fazzi”LecceItaly

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