Suppressive Effect of Angiotensin II Receptor Blockers on Progression of Atherosclerosis as Assessed by 3-Dimensional Carotid Ultrasound

Abstract

The effect of antihypertensive therapy with ARB on carotid endothelium in diabetic patients with hypertension by using 2- and 3-dimensional ultrasonography has received little attention. We investigated whether significant differences exist between telmisartan and valsartan or not in carotid intima-media thickness and plaque volume. Eighty-six type 2 diabetic, hypertensive patients received nateglinide and Telmisartan 40 mg or Valsartan 80 mg for 6 months and were evaluated for bilateral maximum IMT and plaque volume by 2-/3-dimensional ultrasonography. Baseline characteristics in groups telmisartan and valsartan(n=43 each) were: age, 62.0 and 65.0 years; Body Mass Index, 24.6 and 24.4kg/m2; duration of diabetes, 7.0 and 9.0 years; and HbA1c, 7.0 and 6.9%, respectively. Systolic/diastolic blood pressures in group telmisartan vs. valsartan were 143.0/84.0 vs. 144.0/83.0 at baseline and 127.0/76.0 vs. 130.0/74.0 mmHg after antihypertensive therapy, with all later values significantly lower than those at baseline(all P<0.001). Bilateral maximum IMT in group telmisartan vs. valsartan, as assessed by 2-dimensional ultrasonography, were 1.54 vs. 1.72 at baseline and 1.51 mm vs. 1.62 mm after antihypertensive therapy, without significant differences between groups. Plaque volume in group telmisartan vs. valsartan, as assessed by 3-dimensional ultrasonography, at baseline and post-antihypertensive therapy, based on 15 measurements, were 57.3 and 42.6 mm3(P<0.001) vs. 70.8 and 47.9 mm3(P<0.001), respectively, with significant reductions revealed after antihypertensive therapy in both groups, but without significant differences between groups. Significant reductions in plaque volume demonstrated that ARB-based antihypertensive therapy with telmisartan or valsartan was efficacious in suppressing the progression of carotid atherosclerosis as assessed by 3-dimensional ultrasonography. Disclosure K. Taki: None. R. Nishimura: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Astellas Pharma US, Inc., Eli Lilly and Company, Abbott, Medtronic, MSD K.K., Novo Nordisk A/S, Sanofi, Takeda Development Center Asia, Pte. Ltd., Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd.. M. Nishioka: None. Y. Miyashita: None. T. Yokota: None. T. Daisuke: None. A. Morimoto: None. N. Tajima: None. K. Utsunomiya: None.