Choi Geun Joo, Kim Hyun Min, Kang Hyun, Kim Jaetaek
a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Korea ;
b Division of Endocrinology and Metabolism, Department of Internal Medicine , Chung-Ang University College of Medicine , Seoul , Korea.
Curr Med Res Opin. 2016 Jul;32(7):1303-9. doi: 10.1185/03007995.2016.1171204. Epub 2016 Apr 18.
Several meta-analyses have confirmed the positive metabolic effects of telmisartan, an angiotensin II receptor blocker that can also act as a partial peroxisome proliferator-activated receptor-γ agonist, compared to those of other angiotensin II receptor blockers. These effects include decreased fasting glucose, glycosylated hemoglobin, interleukin-6, and tumor necrosis factor-α levels. However, no systemic analysis of telmisartan's effects on body fat distribution has been performed. We performed a meta-analysis of randomized controlled telmisartan trials to investigate its effects on body weight, fat distribution, and visceral adipose reduction.
A literature search was performed using Embase, MEDLINE, and the Cochrane Library between January 1966 and November 2013. Randomized controlled trials in English and meeting the following criterion were included: random assignment of hypertensive participants with overweight/obesity, metabolic syndrome, or glucose intolerance to telmisartan or control therapy group.
Of 651 potentially relevant reports, 15 satisfied the inclusion criterion. While visceral fat area was significantly lower in the telmisartan group than in the control group (weighted mean difference = -18.13 cm(2), 95% C.I. = -27.16 to -9.11, Pχ(2) = 0.19, I(2) = 41%), subcutaneous fat area was similar (weighted mean difference =2.94 cm(2), 95% C.I. = -13.01 to 18.89, Pχ(2) = 0.30, I(2) = 17%). Total cholesterol levels were significantly different between the groups (standardized mean difference = -0.24, 95% C.I. = -0.45 to -0.03, Pχ(2) = 0.0002, I(2) = 67%).
Limitations include: (1) limited number of studies, especially those evaluating fat distribution; (2) different imaging modalities to assess visceral fat area (V.F.A.) and subcutaneous fat area (S.F.A.); (3) observed heterogeneity.
The findings suggest that telmisartan affected fat distribution, inducing visceral fat reduction, and thus could be useful in hypertensive patients with obesity/overweight, metabolic syndrome, or glucose intolerance.
多项荟萃分析已证实，与其他血管紧张素II受体阻滞剂相比，替米沙坦具有积极的代谢效应。替米沙坦是一种血管紧张素II受体阻滞剂，也可作为部分过氧化物酶体增殖物激活受体γ激动剂。这些效应包括空腹血糖、糖化血红蛋白、白细胞介素-6和肿瘤坏死因子-α水平降低。然而，尚未对替米沙坦对身体脂肪分布的影响进行系统分析。我们对替米沙坦随机对照试验进行了荟萃分析，以研究其对体重、脂肪分布和内脏脂肪减少的影响。
于1966年1月至2013年11月期间，使用Embase、MEDLINE和Cochrane图书馆进行文献检索。纳入符合以下标准的英文随机对照试验：将患有超重/肥胖、代谢综合征或葡萄糖不耐受的高血压参与者随机分配至替米沙坦组或对照治疗组。
在651篇可能相关的报告中，15篇符合纳入标准。替米沙坦组的内脏脂肪面积显著低于对照组（加权平均差=-18.13cm²，95%置信区间=-27.16至-9.11，Pχ²=0.19，I²=41%），皮下脂肪面积相似（加权平均差=2.94cm²，95%置信区间=-13.01至18.89，Pχ²=0.30，I²=17%）。两组之间的总胆固醇水平存在显著差异（标准化平均差=-0.24，95%置信区间=-0.45至-0.03，Pχ²=0.0002，I²=67%）。
局限性包括：（1）研究数量有限，尤其是评估脂肪分布的研究；（2）评估内脏脂肪面积（V.F.A.）和皮下脂肪面积（S.F.A.）的成像方式不同；（3）观察到的异质性。
研究结果表明，替米沙坦影响脂肪分布，可减少内脏脂肪，因此可能对患有肥胖/超重、代谢综合征或葡萄糖不耐受的高血压患者有用。
