The effect of Ramipril and Telmisartan on blood pressure and insulin resistance in hypertensive patients

Background: Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) have become keystones of therapy for hypertension but there are very few studies where they have been compared with each other. This study attempted to compare the effect of Ramipril and Telmisartan on Blood Pressure and Insulin Resistance in Hypertensive patients (JNC 8).Methods: An open label, randomized, prospective and comparative study of twelve- week duration was conducted on 60 patients of hypertension (JNC-8), with the collaboration of Department of Pharmacology and Department of Medicine, Government Medical College, Amritsar. Group A and B were given Telmisartan 40mg and Ramipril 2.5 mg OD respectively. Blood Pressure was recorded on every visit, whereas, fasting plasma insulin and HOMA-IR values were recorded at the baseline and at the end of the study. Fasting blood sugar was done at 0, 4 and 12 weeks.Results: At the end of 12 weeks, a significant reduction in Systolic/Diastolic blood pressure was observed in group A with a drop of ~14/9 mmHg (p<0.001) and in group B too, the fall of ~11.6/7.2 mmHg was significant (p<0.001). However, in inter-group comparison only SBP difference was significant between two groups (p<0.05). Change in HOMA-IR value was also significant in both the groups (p<0.001). The inter-group difference for HOMA-IR between both the groups (A vs B) was also statistically significant (p<0.01).Conclusions: Telmisartan 40 mg OD was more effective than Ramipril 2.5 mg OD in controlling the SBP and improving Insulin resistance at the end of 12 weeks.