Telmisartan combined with high-intensity rosuvastatin did not significantly improve HOMA-IR compared to amlodipine (p=0.809), but significantly reduced new-onset diabetes mellitus (12.5% vs 31.4%).
RCT (n=99)
Open-label
Permuted-block randomization
Yes
Does telmisartan improve insulin resistance compared to amlodipine in hypertensive ASCVD patients with IFG on high-intensity rosuvastatin?
While telmisartan did not improve HOMA-IR compared to amlodipine, it reduced fasting glucose and the incidence of new-onset diabetes in hypertensive ASCVD patients with IFG on high-intensity statins.
Absolute Event Rate: 2.4% vs 2.7%
p-value: p=0.809
BACKGROUND: There is lacking evidence that telmisartan can improve insulin resistance in patients on high-intensity statins. This study compared the effects of telmisartan and amlodipine on glucose metabolism in hypertensive atherosclerotic cardiovascular disease (ASCVD) patients with impaired fasting glucose (IFG) requiring high-intensity rosuvastatin therapy. METHODS: Ninety-nine patients were randomly assigned to 2 groups telmisartan-statin group (n=48) and amlodipine-statin group (n=51) as add-on therapy to high-intensity rosuvastatin therapy (20 mg). The primary endpoint was to assess insulin resistance using the homeostatic model assessment (HOMA-IR) value at week 24. The secondary endpoint was the change in glucose metabolism indices from baseline to week 24. RESULTS: The HOMA-IR at week 24 (2.4 interquartile range, 1.8-3.8 versus 2.7 1.7-3.7; P = .809) and changes in the HOMA-IR from baseline to week 24 (-7.0 -29.0 to 21.0 versus -5.5 -53.3 to 27.3; P = .539) were not significantly different between 2 groups. However, the fasting glucose level at week 24 was significantly lower in the telmisartan-statin group than in the amlodipine-statin group (107.7 ± 13.4 mg/dL versus 113.3 ± 12.4 mg/dL; P = .039) and significantly decreased in the telmisartan-statin group (-3.2 ± 8.6% versus 3.8 ± 13.2%; P = .003). The proportion of patients with fasting glucose ≥100 mg/dL (71.1% versus 89.6%; P = .047) or new-onset diabetes mellitus (12.5% versus 31.4%, P = .044) at week 24 was also significantly lower in the telmisartan-statin group than in the amlodipine-statin group. CONCLUSION: In comparison to amlodipine, telmisartan did not decrease the HOMA-IR. However, telmisartan preserved insulin secretion, led to a regression from IFG to euglycemia and prevented new-onset diabetes mellitus in ASCVD patients with IFG requiring high-intensity statins.
Lee et al. (Fri,) conducted a rct in Hypertensive atherosclerotic cardiovascular disease (ASCVD) with impaired fasting glucose (IFG) (n=99). Telmisartan and Rosuvastatin vs. Amlodipine 5-10 mg and rosuvastatin 20 mg once daily was evaluated on Homeostatic model assessment for insulin resistance (HOMA-IR) at week 24 (p=0.809). Telmisartan combined with high-intensity rosuvastatin did not significantly improve HOMA-IR compared to amlodipine (p=0.809), but significantly reduced new-onset diabetes mellitus (12.5% vs 31.4%).