Abstract
Backgrounds: Recently, assessment of the plaque composition has become possible using an integrated backscatter intravascular ultrasound (IB-IVUS). The pleiotropic effect of telmisartan has been focused, however, effects of telmisartan on coronary plaque component and inflammatory cytokines are not known. Methods: A total of 31 patients with hypertension were randomized to two groups: telmisartan group (treatment with telmisartan [80mg/day, n=16]) or control group (other antihypertensive drugs except renin-angiotensin system blocker, n=15) for six months. The tissue characteristics of target coronary plaque in each patient were analyzed using IB-IVUS before and after treatment. We also measured plasma levels of inflammatory cytokines sampled in coronary sinus (CS) and peripheral vein (PV). Results: Mean lumen area significantly increased (7.9±2.2 to 8.5±2.6 mm2, p<0.05) and plaque volume significantly decreased (21.1±6.0 to 19.4±6.2 mm3, p<0.01) after treatment with telmisartan. Additionally, significant increases of fibrous volume (47.3±9.3 to 63.1±4.1%, p<0.05) and reduction of lipid volume (37.5±15.4 to 24.8±8.6%, p<0.05) were observed on IB image analyses in the telmisartan group, while there were no significant changes in plaque component in the control group. The CS-levels of MMP3 and hsCRP were smaller after than before treatment with telmisartan (7.6±6.1 to 5.5±4.9 ng/ml, 5.6±6.0 to 2.2±2.4 mg/l, p<0.05, respectively), however, there were no significant differences in cytokine levels between pre- and post-treatment with other antihypertensive drugs. In the PV-levels of those cytokines, there were no significant differences between pre- and post-treatment in the two groups. Conclusions: Decreased local inflammatory response and plaque stabilization on IB image analyses were observed after six months of telmisartan treatment. These findings might be associated with local anti-inflammatory and antiarteriosclerotic effects of telmisartan.
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