Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
J Clin Pharm Ther. 2012 Jun;37(3):319-27. doi: 10.1111/j.1365-2710.2011.01295.x. Epub 2011 Aug 17.
Telmisartan is an angiotensin receptor blocker (ARB) originally developed for the treatment of hypertension. It can also partially activate peroxisome proliferator-activated receptor (PPAR)-γ, which may improve insulin sensitivity. This effect may prove useful in hypertensive patients with insulin resistance or diabetes mellitus. Such activity is more marked than that observed with other ARBs. This systematic review and meta-analysis evaluated the benefit of telmisartan on insulin sensitivity compared with that of other ARBs in hypertensive patients who had either insulin resistance or diabetic states.
Clinical trials of telmisartan were identified through electronic searches (MEDLINE, CINAHL, Scopus, and The Cochrane Library) up to and including May 2011. Studies were included if they met the following inclusion criteria: (i) randomized controlled trials that compared telmisartan with other ARBs in hypertensive patients who had insulin resistance or type 2 diabetes mellitus; (ii) using telmisartan as an add-on therapy or a monotherapy for treating hypertension; and (iii) reporting fasting plasma glucose (FPG) and fasting plasma insulin (FPI), or homeostasis model assessment of insulin resistance (HOMA-IR), or adiponectin as an outcome measure. Treatment effect was estimated with the mean difference in the final value of FPG, FPI, HOMA-IR and adiponectin between the telmisartan and the control groups.
Eight trials involving a total of 763 patients met the inclusion criteria. Telmisartan was superior to other ARBs in reducing FPG level (mean difference, -8·63 mg/dL; 95% CI -12·29 mg/dL to -4·98 mg/dL; P < 0·00001) and increasing adiponectin level (mean difference, 0·93 μg/dL; 95% CI 0·28 μg/dL to 1·59 μg/dL; P = 0·005). At 80 mg dose, telmisartan may reduce FPI level and HOMA-IR.
The available evidence suggests a beneficial effect of telmisartan in improving insulin sensitivity in hypertensive patients with insulin resistance or diabetes as demonstrated by the decrease in FPG and increase in adiponectin levels. The effect in decreasing FPG was greater with 80 mg dose than with the 40 mg dose. FPI and insulin resistance may be improved with 80 mg of telmisartan.
替米沙坦是一种血管紧张素受体阻滞剂（ARB），最初用于治疗高血压。它还可以部分激活过氧化物酶体增殖物激活受体（PPAR）-γ，从而改善胰岛素敏感性。这种作用在伴有胰岛素抵抗或糖尿病的高血压患者中可能很有用。这种活性比其他 ARB 观察到的更明显。本系统评价和荟萃分析评估了替米沙坦在改善胰岛素敏感性方面相对于其他 ARB 的益处，这些 ARB 用于伴有胰岛素抵抗或糖尿病状态的高血压患者。
通过电子搜索（MEDLINE、CINAHL、Scopus 和 The Cochrane Library）检索截至 2011 年 5 月的替米沙坦临床试验。如果符合以下纳入标准，则纳入研究：（i）比较替米沙坦与其他 ARB 在伴有胰岛素抵抗或 2 型糖尿病的高血压患者中的随机对照试验；（ii）将替米沙坦作为添加治疗或单药治疗用于治疗高血压；（iii）报告空腹血糖（FPG）和空腹血浆胰岛素（FPI），或稳态模型评估的胰岛素抵抗（HOMA-IR），或脂联素作为结局指标。用替米沙坦组和对照组之间 FPG、FPI、HOMA-IR 和脂联素的最终值的均数差值估计治疗效果。
共有 8 项试验共纳入 763 名患者符合纳入标准。替米沙坦在降低 FPG 水平方面优于其他 ARB（平均差异，-8.63 mg/dL；95%CI -12.29 mg/dL 至-4.98 mg/dL；P < 0.00001）和增加脂联素水平（平均差异，0.93 μg/dL；95%CI 0.28 μg/dL 至 1.59 μg/dL；P = 0.005）。在 80 mg 剂量时，替米沙坦可能降低 FPI 水平和 HOMA-IR。
现有证据表明，替米沙坦在改善伴有胰岛素抵抗或糖尿病的高血压患者的胰岛素敏感性方面具有有益作用，这表现为 FPG 降低和脂联素水平升高。80 mg 剂量的效果大于 40 mg 剂量。替米沙坦 80 mg 可改善 FPI 和胰岛素抵抗。
