The use of telmisartan in the treatment of arterial hypertension with obesity

Abstract

The combined course of arterial hypertension (AH) with overweight or abdominal obesity is considered as one of the most common type of comorbid pathology leading to a significant increase of cardiovascular complications. Aim. To study the effects of telmisartan on the intracardiac hemodynamics, the functional state of the myocardium, the lipid and carbohydrate profile in patients with arterial hypertension (AH) and obesity. Materials and methods. 50 patients with AH of stage II were examined, they were divided into 2 groups. The first (main) group consisted of 23 patients with stage II arterial hypertension and the normal body weight. In the second group (reference group) there were 27 patients, who were diagnosed with AH of stage II and obesity. The diagnosis was verified using laboratory instrumental methods in accordance with the recommendations of the European Cardiologic Society (2013). Obesity was assessed by the body mass index and the waist to the hip ratio. The lipid profile was determined by the enzymatic method. Results. It has been found in the study that the level of values of systolic blood pressure (SBP) in hypertensive patients with the normal body weight treated with telmisartan decreased by 14.5 %, while diastolic blood pressure (DBP) reduced by 11.4 %. In patients with AH of stage II having obesity the SBP level also decreased by 13.4 % and DBP – by 11.5 %. In 3 months of treatment the regression dynamics of the end-diastolic and end-systolic dimensions of the heart in the group of patients without obesity led to a significant decrease in these parameters compared to the baseline values. In obese patients these indicators also decreased; however, they did not reach reliable values. When treating with telmisartan there was a decrease in lipids in AH patients (total cholesterol (TC)– (5.5 %), cholesterol of low density lipoproteins (LDL) – 6.2 %, triglycerides (TG) 7.8 %, cholesterol of HDL – by 10.4 % (p <0.05), there were also unreliable changes in AH patients associated with obesity (total cholesterol – by 5.9 %, LDL – 5.1 %, TG – 8.8 % and increased cholesterol of HDL – by 6.4 %). After the treatment the indicators of carbohydrate metabolism decreased (glycosylated hemoglobin (HbA1c) by 8.45 % and 19.17 %, insulin – by 3.2 % and 13.38 % glucose – by 5.65 % and 4.73 %, respectively, in groups). Conclusions. The study has shown that telmisartan has indirect positive effects on intracardiac hemodynamics due to decrease of blood pressure both in AH patients having the normal body weight and patients with obesity. The use of telmisartan as an antihypertensive agent gives a hypolipidemic effect, improves the parameters of the carbohydrate metabolism in AH patients with the normal body weight and with obesity. These data can be markers for assessing the effectiveness of hypotensive therapy with telmisartan.