Losartan versus Telmisartan in Overweight Patients with Arterial Hypertension

Abstract

Background and Objectives : Obesity exacerbates hypertension and stimulates the renin-angiotensin-aldosterone system (RAAS). RAAS inhibition could be a therapeutic option in overweight patients with hypertension. This study compared two angiotensin-receptor blockers to determine their effect on blood pressure (BP) and different cardiovascular risk factors in these patients. Methods : We conducted a 24-week, single-blind, randomized, parallel-group study in 60 overweight or obese patients (body mass index ≥27 kg/m 2 ) with hypertension, aged 18-60 years. The primary endpoint of the study was change in mean 24-h systolic BP and diastolic BP from baseline to study end. Central BP, arterial stiffness, and metabolic and cardiac indices were also investigated. Patients were randomly allocated to losartan 100 mg/day or telmisartan 80 mg/day. Nonpharmacological interventions were also recommended in both groups. Results : Reduction in mean 24-h systolic BP (and diastolic BP) was all significant (p <0.05 versus baseline) for losartan and telmisartan: systolic BP -12 and -15 mmHg, respectively; diastolic BP -13 and -12 mmHg, respectively. Aortic elasticity improved with telmisartan only. Telmisartan was associated with the greatest reduction in central aortic BP, levels of leptin (14 % versus 7 %) and hs-CRP (23% versus 8%) and greatest increase of adiponectin level (13% versus 5%) versus losartan, respectively (p< 0.05 for all). Reduction in other BP, echocardiographic, metabolic and anthropometric parameters occurred with both treatments. Conclusion : both angiotensin-receptor blockers effectively reduce BP, improve arterial structure and regulate cardiovascular risk factors in overweight patients with hypertension, but telmisartan has more favorable effects on leptin, adiponectin and hs-CRP levels.