Comparative Study Of Angiotensin Receptor Blocker With Or Without Ppar-Gamma Properties On Endothelial Function And Aortic Stiffness In Hypertensive Patients With Chronic Kidney Disease And The Metabolic Syndrome

Background: Chronic kidney disease (CKD) and the metabolic syndrome(MetS) are recognized as risk factors for cardiovascular disease. Recently it has been reported that telmisartan and irbesartan, angiotensin receptor blockers (ARB), has an action of PPAR - γ agonist. We compared the effects on endothelial function and aortic stiffness in hypertensive patients with CKD and MetS between angiotensin receptor blockers with PPAR-γ properties (telmisartan and irbesartan) and without PPAR-γ properties (losartan and valsartan). Methods: Ninety six untreated hypertensive patients with CKD (stage 3) and the metabolic syndrome were randomized to receive telmisartan (Telmisartan group, n=26, 20-40 mg/day), irbesartan (Irbesartan group, n=23 100-200 mg/day), losartan (Losartan group, n=22, 50-100 mg/day) or valsartan (Valsartan group, n=25, 80-160 mg/day). Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of brachial artery were measured by using ultrasound system. Pulse wave velocity (PWV) was measured by using oscilometric technique (form PWV/ABI ® , Colin Co, Japan). We also assessed insulin resistance by HOMA-IR. Measurements were performed at baseline, and then at 6 and 12 months after the treatments. Results: At baseline, there were no differences in FMD, PWV, and HOMA-IR between the four groups. After 12 months, there was no difference in blood pressure between four groups. FMD were significantly increased, and PWV was significantly decreased in four groups as compared with the baseline. However, these improvements were much better in the telmisartan group and the irbesartan group as compared with the losartan group and the valsartan group, and HOMA-IR was improved only in the telmisartan group and the irbesartan group. Conclusion: Telmisartan and irbesartan with PPAR-γ properties improve not only insulin resistance, but also endothelial function and aortic stiffness in hypertensive patients with CKD and MetS.