Abstract:

No study has analyzed the extent of weight reducing ability among the “peroxisome proliferator activated receptor-gamma” (PPAR-γ) activating ARBs – Telmisartan and Irbesartan in black hypertensive of African origin. This retrospective cohort study was designed to delineate the extent of weight reducing effect of these PPAR-γ activating ARBs and how it correlates with BP reduction observed with these ARBs in black hypertensive. A total of 26 case notes of patients (15 men, 11 women; mean age 58.9±1.8 years) with diagnosis of hypertension were reviewed and the study attained a power of 96%. The patients whose case notes were reviewed were naïve to ARBs before commencing either telmisartan or irbesartan and did not have any metabolic disease like diabetes or thyroid disease which could interfere with body weight reading. They all took either telmisartan 80mg or irbesartan 150mg for at least a 6 month review period. Body weight were significantly reduced more in the telmisartan (n = 13) treatment group compared to the irbesartan(n = 13) treatment group [change from baseline; -1.51±0.46Kg (-1.68%), P=0.006 vs. -0.96±0.15Kg (-1.05%), P<0.001]. Both treatment effectively controlled blood pressure (mean BP after 6 months treatment: Telmisartan 126/83mmHg; Irbesartan 133/84mmHg). In the telmisartan group there were no correlation between either change in SBP and change in body weight (r = -0.220, P = 0.471) or change in DBP and change in body weight (r = -0.050, P = 0.870), but a significant positive correlation was observed between both change in SBP and change in body weight (r = 0.538, P = 0.058) and change in DBP and change in body weight (r = 0.610, P = 0.027) in the irbesartan treatment group. Both telmisartan and irbesartan reduced body weight in hypertensive black patients and this reduction in body weight may contribute to the power demonstrated by irbesartan to get patients to BP goal. Hence hypertensive blacks could also benefit from the established end-organ protection benefits of both telmisartan and irbesartan.

Keywords: Hypertension; Telmisartan; Irbesartan; Body weight; Adiponectin; PPAR-γ.

References:

[1.]   AHA. American Heart Association. Metabolic “footprint” may be new measure of obesity risk in kids. 4TH annual conference on cardiovascular diseases, epidemiology and prevention, 2004.

[2.]   Burt, V.L., Whelton, P., Roccella, E.J., Brown, C., Cutler, J.A., Higgins, M., et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey. 1988-1991. Hypertension, 1995, 25(3), 305-313.

[3.]   Clasen, R., Schupp, M., Foryst-Ludwig, Anna., et al. PPAR gamma-activating angiotensin type-1 receptor blockers induce adiponectin. Hypertension, 2005, 46(1): 137-143.

[4.]   De las Heras, N., Martin-Fernandez B, Miana M, et al. The protective effect of irbesartan in rats fed a high fat diet is associated with modification of leptin-adiponectin imbalance. J Hypertens, 2009, 6(Suppl.): S37-41.

[5.]   Derosa, G., Cicero, A.F., D`Angelo, A., et al. Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects in insulin resistance, leptin and tumor necrosis factor-alpha. Hypertens Res., 2006, 11: 849-56.

[6.]   Fasshauer, M., Paschke, R., Stumvoll, M. Adiponectin, obesity and cardiovascular disease. Biochimie, 2004, 86: 779-784

[7.]   He, J., Whelton, PK., Appel, L J., Charleston, J., Klag, MJ. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension, 2000, 35:544-9.

[8.]   HOPE Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. N Engl J Med., 2000, 342: 145-53.

[9.]   Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P.K. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365: 217–23.

[10.]      Koh, K.K., Quon, M.J., Han, S.H., et al. Vascular and metabolic effects of combined therapy with ramipril and simvastatin in patients with type 2 diabetes. Hypertension, 2005, 45: 1088-1093.

[11.]      Lewis, E.J., Hunsicker, L.G., Clarke, W.R., et al. for the Collaborative study group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med., 2001, 345(12): 851-860.

[12.]      Makita, S., Abiko, A., Naganuma, Y., Moriai, Y., Nakamura, M. Effects of telmisartan on adiponectin levels and body weight in hypertensive patients with glucose intolerance. Metabolism, 2008, 10: 1473-1478.

[13.]      Mori, H., Okada, Y., Arao, T., Nishida, K., Tanaka, Y. Telmisartan at 80mg/day increases high-molecular-weight adiponectin levels and improves insulin resistance in diabetic patients. Adv Ther, 2012, 29(7): 635-44.

[14.]      Negro, R., Formoso, G., Hassan, H. The effects of irbesartan and telmisartan on metabolic parameters and blood pressure in obese, insulin resistant, hypertensive patients. J Endocrinol Invest., 2006, 29(11): 957-61.

[15.]      ONTARGET Investigators, Yusuf, S., Teo, K.K., et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med., 2008, 358:1547–1559.

[16.]      Ouedraogo, R., Ging, Y., Berzins, B., Wu, X., Mahadev, K., Hough, K., Chan, L., Goldstein, B.J., Scalia, R. Adiponectin deficiency increases leucocytes endothelium interactions via upregulation of endothelial cell adhesion molecules in vivo. J Clin Invest., 2007, 117: 1718-1726.

[17.]      Parhofer, K.G., Munzel, F., Krekler, M. Effect of the angiotensin receptor blocker irbesartan on metabolic parameters in clinical practice: the DO-IT prospective observational study. Cardiovascular Diabetology, 2007, 6: 36-41.

[18.]      Parving, H-H., Lennert, H., Brochner-mortensen, J., Gomis, R., Andersen, S., Avner, P. The effect of irbesartan on the development of diabetic nephropathy in patients with type-2 diabetes. N Engl J Med., 2001, 345(12): 870-78.

[19.]      THPCRG Investigators (Trials of Hypertension Prevention Collaborative Research Group).Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. Arch Intern Med., 1997, 157:657-67.

[20.]      World Health Report (2002) Reducing risks, promoting healthy life. World Health Organization, Geneva, Switzerland. http://www.who.int/whr/2002/en/whr02_en.Pdf