An observational cross-sectional study to determine the effect of telmisartan on reducing microalbuminuria in diabetic hypertensive patients in tertiary care teaching hospital, Central India
Keywords:Diabetic nephropathy, Microalbuminuria, Telmisartan
Background: There are many groups of drugs to decrease microalbuminuria like angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers and direct vasodilators. Among these, ACEI and ARBs are commonly used for this purpose. If side effects occur, ACEI are replaced with ARBs. Many ARBs have been studied for their effect on reducing microalbuminuria, but data on telmisartan with its additional unique properties are scarce in Indian population.
Methods: This cross sectional observational study was carried out in a tertiary care centre. We first measured base line urine albumin levels in included patients, 3 months after treatment with telmisartan using ‘hemocue urine albumin analyser’. We collected and compared both baseline and after treatment data of microalbuminuria and analysed in descriptive statistics.
Results: A total of 110 patients participated in this study; out of which 10 patients were excluded from the study because they were not available for follow up. As compared to baseline, urine albumin level decreased by 30.42% after 12 weeks treatment with telmisartan (P <0.001).
Conclusions: Microalbuminuria is one of the leading cause of end stage renal disease and coronary heart diseases in diabetic hypertensive patients. Drugs like ACE inhibitors, Angiotensin receptor blockers, Calcium channel blockers and direct vasodilators are used to prevent these complications. In this present study, we concluded that telmisartan decreases urine albumin excretion around 30.42% from baseline after 12 weeks of treatment.
US Renal Data System. USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Diseases in the United States. 2007 National Institutes of Health, National Institutes of Diabetes, Digestive Diseases and Kidney Diseases www.usrds.org last accessed 2/1/08.
Rowe DJ, Dawnay A, Watts GF. Microalbuminuria in diabetes mellitus: review and recommendations for the measurement of albumin in urine. Ann 1990 Jul;27:297-312.
Hillege HL, Fidler V, Diercks GF. Urinary albumin excretion predicts cardiovascular and non cardiovascular mortality in general population. Circulation. 2002;106:1777-82.
Bakris G. Clinical trials report. Proteinuria and blood pressure reduction: are they of equal importance to preserve kidney function? CurrHypertens Rep. 2005;7:357-8.
Lea J, Greene T, Hebert L, Lipkowitz M, Massry S, Middleton J, et al. The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Archives of internal medicine. 2005 Apr 25;165(8):947-53.
De Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney international. 2004 Jun 30;65(6):2309-20.
Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Oxidative stress and stress-activated signaling pathways: a unifying hypothesis of type 2 diabetes. Endocr Rev. 2002;23:599-622.
Sarafidis PA, Khosla N, Bakris GL. Antihypertensive therapy in the presence of proteinuria. Am J Kidney Dis. 2007;49:12-26.
Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. American journal of kidney diseases. 2000 Sep 30;36(3):646-61.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. hypertension. 2003 Dec 1;42(6):1206-52.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2007 Jun 1;28(12):1462-536.
Benson SC, Pershadsingh HA, Ho CI, Chittiboyina A, Desai P, Pravenec M, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPAR gamma-modulating activity. Hypertension. 2004;43:993-1002.
Janke J, Schupp M, Engeli S, Gorzelniak K, Boschmann M, Sauma L, et al. Angiotensin type 1 receptor antagonists induce human in-vitro adipogenesis through peroxisome proliferator-activated receptor gamma Activation. J Hypertens. 2006;24:1809-16.
Schupp M, Janke J, Clasen R, Unger T, Kintscher U. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation. 2004;109:2054-7.
Burnier M. Angiotensin II type 1 receptor blockers. Circulation. 2001;103:904-12.
Bakris G, Burgess E, Weir M, Davidai G, Koval S. Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int. 2008;74:364-9.
Toyama K, Nakamura T, Kataoka K, Yasuda O, Fukuda M, Tokutomi Y, et al. Telmisartan protects against diabetic vascular complications in a mouse model of obesity and type 2 diabetes, partially through peroxisome proliferator activated receptor-γ-dependent activity. Biochemical and biophysical research communications. 2011 Jul 8;410(3):508-13.
The ONTARGET Investigators N Engl J Med. 2008;358:1547-59.
Leon G. Fine and Salehmoghaddam. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd Edition.
Borch-Johnsen K. the prognosis of insulin-dependent diabetes mellitus.an epidemiological approach. Dan med bull. 1989;39:336-49.
Ballard DJ, Humphrey LL, Melton LJ, Frohnert PP, Chu CP, O'Fallon WM, et al. Epidemiology of persistent proteinuria in type II diabetes mellitus: population-based study in Rochester, Minnesota. Diabetes. 1988 Apr 1;37(4):405-12.
Gall MA, Borch-Johnsen K, Hougaard P, Nielsen FS, Parving HH. Albuminuria and poor glycemic control predict mortality in NIDDM. Diabetes. 1995 Nov 1;44(11):1303-9.
Cosentino F, Hishikawa K, Katusic ZS, Luscher TF. High glucose increases nitric oxide synthase expression and superoxide anion generation in human aortic endothelial cells. Circulation. 1997;96:25-8.
Fujita H, Fujishima H, Chida S, Takahashi K, Qi Z, Kanetsuna Y, et al. Reduction of renal superoxide dismutase in progressive diabetic nephropathy.J Am Soc Nephrol. 2009;20:1303-13.
Sugiyama H, Kobayashi M, Wang DH, Sunami R, Maeshima Y, Yamasaki Y, et al. Telmisartan inhibits both oxidative stress and renal fibrosis after unilateral ureteral obstruction in acatalasemic mice. Nephrol Dial Transplant. 2005;20:2670-80.