Azilsartan medoxomil for improving insulin resistance and adipokine levels in hypertension in comparison with angiotensin-converting enzyme inhibitors

Aim. To assess azilsartan medoxomil (AZM) in achieving the target blood pressure (BP) (<140/90 mm Hg), its angioprotective action in patients with hypertension (HTN), as well as contribution in reducing levels of adipokines and inflammation markers in patients switching from lisinopril or enalapril. Material and methods. This open-label observational study lasting 24 weeks included 60 patients who had previously received monotherapy with lisinopril 20 mg/day or enalapril 20 mg/day, and did not reach the target BP levels (<140/90 mm Hg). During the study, all patients underwent 24-hour BP monitoring, applanation tonometry (determination of the augmentation index and central BP), pulse wave velocity measurement, laboratory tests (lipid profile, uric acid, fasting glucose, HOMA index, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein (hs-CRP), tumor necrosis factor alpha, interleukin-6 (IL-6). Results. After switching from lisinopril and enalapril to AZM, a decrease in systolic BP was 24,3% and 31,3%, diastolic BP — 19,8% and 21,4% (p<0,05). In the groups of initial therapy with lisinopril and enalapril, there was a decrease in central (aortic) BP by 20,4% and 25,5%, central pulse pressure by 20,6% and 27,6%, augmentation index by 33,1% and 34,58%, pulse wave velocity by 19,4% and 20,7% (p<0,05), levels of leptin by 10,4%, and 16,8%, hs-CRP by 16,1% and 19,3%, IL-6 by 23,6% and 25,1%, respectively. We also revealed an increase in adiponectin levels by 7,2% and 9,2%, respectively (p<0,05). Conclusion. Azilsartan medoxomil has advantages over angiotensin-converting enzyme inhibitors (enalapril, lisinopril) in achieving BP control, and improving vascular elasticity. It contributes to a decrease in insulin resistance and noninfectious inflammation.