Key result
Telmisartan significantly improved insulin resistance from baseline in nondiabetic patients with mild hypertension and high baseline insulin resistance (p=0.042), though the difference compared to valsartan was not statistically significant (p=0.529).
Why the study?
Does telmisartan improve insulin resistance and adipocytokines compared to valsartan in nondiabetic patients with mild hypertension?
RCT (n=50)
Open-label
Randomly assigned
Yes
Does telmisartan improve insulin resistance and adipocytokines compared to valsartan in nondiabetic patients with mild hypertension?
Absolute Event Rate: -0.3% vs -0.8%
p-value: p=0.529
Telmisartan, but not valsartan, significantly improves insulin resistance in nondiabetic patients with mild hypertension who have high baseline insulin resistance, likely via PPAR-gamma activation.
Telmisartan shows no advantage over valsartan for insulin resistance; leaves open whether PPAR-gamma effects meaningfully alter metabolic outcomes in mild hypertension.
OBJECTIVE: The comparative effect of telmisartan and valsartan upon insulin resistance and adipocytokines in nondiabetic patients with mild hypertension is unclear. METHODS: Fifty nondiabetic patients with untreated mild hypertension were randomly assigned to telmisartan (40 mg/day) and valsartan (80 mg/day) groups and were switched in a crossover manner at 3-month intervals. Serum leptin, adiponectin, hsCRP and the HOMA-R were measured before and at 3 months during each treatment period. RESULTS: The HOMA-R significantly improved over the 3 months in the high insulin resistance group (HOMA-R>/=2.5) during the telmisartan treatment period (p=0.042), but not during the valsartan period. Both telmisartan and valsartan significantly decreased serum leptin levels in each female group during each treatment period (p<0.001 and p<0.001, respectively), but not in the male groups. Serum adiponectin did not increase in either treatment group. Serum hsCRP levels also significantly decreased in the high hsCRP subjects (>/=0.1) of both treatment groups (p=0.044 and p=0.015, respectively). CONCLUSIONS: Telmisartan significantly improved insulin resistance, possibly through the effect on PPAR-gamma, while both telmisartan and valsartan significantly decreased serum leptin levels in female groups and hsCRP in both genders, suggesting no significantly different effects on adipocytokines by either drug in nondiabetic patients with mild hypertension.
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Ohbayashi et al. (2010) conducted an RCT in Untreated mild hypertension in nondiabetic patients (n=50). Telmisartan vs. Valsartan (80 mg/day) was evaluated on Change in HOMA-R in patients with high baseline insulin resistance (HOMA-R ≥ 2.5) (p=0.529). Telmisartan significantly improved insulin resistance from baseline in nondiabetic patients with mild hypertension and high baseline insulin resistance (p=0.042), though the difference compared to valsartan was not statistically significant (p=0.529).
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