The Differential Effects of Angiotensin II Type 1 Receptor Blockers on Microalbuminuria in Relation to Low-Grade Inflammation in Metabolic Hypertensive Patients

Background: A dual angiotensin type 1 receptor blocker (ARB)/peroxisome proliferator-activated receptor-γ (PPARγ) agonist telmisartan may be more useful for microalbuminuria reduction than ARBs with no PPARγ agonistic action. We investigated whether there is a difference between the effects of telmisartan and valsartan with respect to microalbuminuria reduction, and the association with improvement of metabolic features or suppression of the inflammatory state. Methods: Fifty-three patients who had metabolic syndrome and had been taking valsartan were recruited. All of these patients were randomly assigned to replace valsartan by telmisartan (telmisartan group; n = 30) or to keep taking valsartan (control group; n = 21). Various parameters were measured at baseline and 12 weeks after randomization. Results: There were no significant changes in blood pressure (BP), glucose, and lipid parameters between baseline and 12 weeks after randomization in either group. There was a significant increase in high molecular weight adiponectin in the telmisartan group (4.6 v 5.0 μg/mL, P = .024), whereas there was no significant change in the control group. The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group (28.1 v 18.9 mg/g · Cr and 0.77 v 0.60 mg/L, respectively, P = .001 and P = .022), whereas there was no significant change in the control group. The reductions of microalbuminuria and hs-CRP were significantly correlated with each other (γ = 0.413, P = .003). Conclusions: The dual ARB/PPARγ agonist telmisartan achieved more microalbuminuria reduction than an ARB with no PPARγ agonistic action, possibly through suppression of the inflammatory state in metabolic hypertensive patients.