Effects Of Telmisartan On Hs-CRP And HMW-adiponectinin Patients With Essential Hypertension

Background and Objective: High-sensitivity C-reactive protein (hs-CRP) levels are elevated and associated with cardiovascular risk in patients with essential hypertension. High molecular weight (HMW)-adiponectin has been reported to be involved in the pathogenesis of atherosclerosis, with low levels being associated with adverse cardiovas-cular outcomes in patients with coronary artery disease. Telmisartan, an angiotensinⅡ(AngⅡ)-receptor blocker (ARB), is reported to be a partial agonist of the peroxisome proliferator-activated receptor-gamma (PPAR-γ). It is known that the activation of PPAR-γinduces a decrease of hs-CRP and an increase of HMW-adiponectin. This research probes into the effects of telmisartan on hs-CRP and HMW-adiponectin in patients with essential hypertension.Methods: During March to September in 2009, 25 Japanese patients with essential hypertension from internal medicine clinic of department of medicine in Ehime university, who had never been treated with antihyper-tensive agents were enrolled into the study. The diagnostic criteria is referenced of WHO/ISH in 2003, that is systolic blood pressure≥140mmHg and (or) diastolic blood pressure≥90mmHg. What else, except sencondary hypertension, severe cardiac insufficiency, myocarditis, myocardosis, rheumatic heart disease, severe valvular disease, liver and kidney dys- function, diabetes mellitus, acute or chronic infection, primary hyper-uricemia, immunologic diseases, neoplasm through physical and laboratory examinations, except operational trauma, burning, injury, hyperpyrexia, stroke, emaciation, malnutrition in recent two months. Among those patients, there are 15 male and 10 female. The age range from 46 to 79 years old, and the average is 62±13 years old. Exclusion criteria were as follows: current treatment with anti-hypertensive agents, statin, insulin or oral antihyper-glycemic agents such as sulfonylureas, metformin or thiazolidinediones. The patients were treated with telmisartan (20 mg daily) alone as initial dose. After one or three months, if systolic blood pressure>140mmHg or diastolic blood pressure>90mmHg, then the dose is increased to 40 mg daily till 24 weeks in total. Blood pressure levels are measured, and metabolic parameters including hs-CRP and HMW-adiponectin, fasting plasma glucose, TG, LDL-C, HDL-C were measured at baseline and after 24-weeks of treatment with telmisartan. It's observed the controlled levels of blood pressure, metabolic parameters including hs-CRP and HMW- adiponectin in patients over telmisartan. SPSS 15.0 software package is used to analyse data of research results.Results: Treatment with telmisartan caused a significant decrease in both systolic and diastolic blood pressure: systolic blood pressure from 156±18mmHg to 137±20mmHg(P<0.001); diastolic blood pressure from 93±13mmHg to74±10mmHg(P﹦0.006). In addition, the natural logarithm of hs-CRP decreased from-2.69 to -3.11 P﹦0.036, and the natural logarithm of HMW- adiponectin increased from 0.69 to 0.84(P﹦0.021). There weren't significant differences between baseline and after treatment of telmisartan in fasting plasma glucose, TG, LDL-C, HDL-C(P>0.05).Conclusions:1. Telmisartan is effective for controlling systolic and diastolic in patients with essential hypertension.2. Telmisartan is effective for decreasing hs-CRP and increasing HMW-adiponectin levels, which proofed that telmisartan is attributable to the partial agonist action of PPAR-γ.