Yano Yuichiro, Hoshide Satoshi, Ishikawa Joji, Noguchi Chishio, Tukui Daisuke, Takanori Hidaka, Tada Masashi, Kanemaru Yoshimasa, Yano Ayako, Ishikawa Shizukiyo, Shimada Kazuyuki, Kario Kazuomi
Department of Internal Medicine, Misato Town National Health Insurance Nango Hospital, Miyazaki, Japan.
Am J Hypertens. 2007 May;20(5):565-72. doi: 10.1016/j.amjhyper.2006.12.008.
A dual angiotensin type 1 receptor blocker (ARB)/peroxisome proliferator-activated receptor-gamma (PPARgamma) agonist telmisartan may be more useful for microalbuminuria reduction than ARBs with no PPARgamma agonistic action. We investigated whether there is a difference between the effects of telmisartan and valsartan with respect to microalbuminuria reduction, and the association with improvement of metabolic features or suppression of the inflammatory state.
Fifty-three patients who had metabolic syndrome and had been taking valsartan were recruited. All of these patients were randomly assigned to replace valsartan by telmisartan (telmisartan group; n = 30) or to keep taking valsartan (control group; n = 21). Various parameters were measured at baseline and 12 weeks after randomization.
There were no significant changes in blood pressure (BP), glucose, and lipid parameters between baseline and 12 weeks after randomization in either group. There was a significant increase in high molecular weight adiponectin in the telmisartan group (4.6 v 5.0 microg/mL, P = .024), whereas there was no significant change in the control group. The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group (28.1 v 18.9 mg/g.Cr and 0.77 v 0.60 mg/L, respectively, P = .001 and P = .022), whereas there was no significant change in the control group. The reductions of microalbuminuria and hs-CRP were significantly correlated with each other (gamma = 0.413, P = .003).
The dual ARB/PPARgamma agonist telmisartan achieved more microalbuminuria reduction than an ARB with no PPARgamma agonistic action, possibly through suppression of the inflammatory state in metabolic hypertensive patients.
双重作用的血管紧张素1型受体阻滞剂（ARB）/过氧化物酶体增殖物激活受体γ（PPARγ）激动剂替米沙坦在降低微量白蛋白尿方面可能比不具有PPARγ激动作用的ARB更有效。我们研究了替米沙坦和缬沙坦在降低微量白蛋白尿的效果上是否存在差异，以及与代谢特征改善或炎症状态抑制之间的关联。
招募了53例患有代谢综合征且一直在服用缬沙坦的患者。所有这些患者被随机分配为用替米沙坦替代缬沙坦（替米沙坦组；n = 30）或继续服用缬沙坦（对照组；n = 21）。在基线和随机分组12周后测量各种参数。
两组在随机分组后12周时血压、血糖和血脂参数与基线相比均无显著变化。替米沙坦组高分子量脂联素显著增加（4.6对5.0μg/mL，P = 0.024），而对照组无显著变化。替米沙坦组微量白蛋白尿和高敏C反应蛋白（hs-CRP）的降低显著（分别为28.1对18.9mg/g.Cr和0.77对0.60mg/L，P = 0.001和P = 0.022），而对照组无显著变化。微量白蛋白尿和hs-CRP的降低彼此显著相关（γ = 0.413，P = 0.003）。
双重ARB/PPARγ激动剂替米沙坦在降低微量白蛋白尿方面比不具有PPARγ激动作用的ARB更有效，可能是通过抑制代谢性高血压患者的炎症状态实现的。
