Long-Term Effects Of Telmisartan, An Angiotensin Ii Receptor Blocker In Hypertensive Patients With Chronic Kidney Disease

Hypertension and Chronic Kidney Disease (CKD) is known as a major risk factor for cardiovascular disease (CVD). This study was designed to investigate endothelial function and long-term outcome of telmisartan, angiotensin II receptor blocker, in hypertensive patients with CKD. Seventy one untreated hypertensive patients with CKD (stage 3 or 4) were randomized to receive telmisartan ( Telmisartan group , n=35) or amlodipine ( Amlodipine group , n=36). 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. We also measured high sensitivity C-reactive peptide (hsCRP) and thiobarbituric acid reactive substance (TBARS) as indexes of inflammation and oxidative stress. The primary outcome was death from CVD, or hospitalization for CVD during a follow-up period 4.2 to 4.7 years (median, 4.4 years). Blood pressure was significantly decreased in the both groups, and there was no difference between two groups at baseline and during study. FMD was significantly increased, and PWV, hsCRP, and TBARS were significantly decreased in the both groups after the treatment. However, these improvements were much better in the telmisartan group as compared with the amlodipine group. The 4.4-year cumulative primary-event rates were 12.6% in the telmisartan group and 37.4% in the amlodipine group (p=0.012 by long-lank test). Telmisartan improves not only endothelial function, PWV, hsCRP, or TBARS, but also long-term cardiovascular outcome in hypertensive patients with CKD.