Study of utilization pattern and analysis of efficacy of newer angiotensin receptor blockers in patients with hypertension and type-II diabetes with or without hypertension

Rajashree Samal, Jyoti Prakash Panda, Kali Prasad Pattnaik


Background: Interventions that target blood pressure control and proteinuria, specifically interruption of the Renin-angiotensin-aldosterone system (RAAS), have been utilized in attenuating cardiovascular complications. Angiotensin receptor blockers (ARBs) have been reported to have certain advantages. The objective of the study was to evaluate and compare the utilization pattern and efficacy of different ARBs in patients with HTN and associated type-II diabetes.

Methods: Hypertensive patients with or without type-II diabetes treated with ARB based regimen were selected.  The BP and 24 hours urinary albumin excretion were analysed at baseline and after three months of treatment.

Results: Mean reduction in systolic blood pressure(SBP) was more with ARBs and calcium channel blocker(CCB) combination. Telmisartan alone and with ACEI reduced diastolic blood pressure (DBP) maximally in diabetic hypertensive patients. Proteinuria was significantly reduced with telmisartan (p<0.001) and olmesartan (p<0.05) based therapy. The side effects were minimal with ARB based therapy. Telmisartan was the costliest among all ARBs

Conclusions: There was suboptimal use of combination therapy in diabetic hypertensive patients.  Telmisartan was having the better control on 24hr urinary albumin excretion.


Angiotensin receptor blockers, AT1 receptor, Hypertension, Type-II diabetes mellitus

Full Text:



Atlas of End-stage Renal Disease in the United States. Excerpts from the United States Renal Data Systems 2002 annual report. Am J Kidney Dis. 2003; 41 4 suppl. 2: v-ix, S7-254.

Wenzel RR, Bruck H, Noll G, et al. Antihypertensive drugs and the sympathetic nervous system. J Cardiovasc Pharmacol. 2000; 357 suppl. 4: S43-52.

Perry HM Jr, Miller JP, Fornoff JR, et al. Early predictors of15-year end-stage renal disease in hypertensive patients. Hypertension. 1995;25:587-94.

Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996;334:13-8.

Young JH, Klag MJ, Muntner P, et al. Blood pressure anddecline in kidney function: findings from the SystolicHypertension in the Elderly Program (SHEP). J Am Soc Nephrol. 2002;13:2776-82.

Ruilope LM, Segura J. Losartan and other angiotensin 11 antagonists for nephropathy in type 2 diabetes mellitus: a review of the clinical trial evidence. Clin Ther. 2003;25:3044-64.

Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch W, Smith SC Jr, Sowers JR. Diabetes and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation. 1999; 100(10):1134-46.

Intensive blood-glucose control with sulphonylurea or insulin compared with conventional treatment and risk of complications in patients with type-2 diabetes mellitus (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53.

Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992 ;19(5):403-18.

Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care. 1993;16(2):434-44.

Cushman WC. Are there benefits to specific antihypertensive drug therapy? Am J Hypertens. 2002;6:31S-35S.

Blood Pressure Lowering Treatment Trialists, Collaboration. Effects of different blood-pressure lowering regimens on major cardiovascular events: Results of prospectively-designed overviews on randomized trials. Lancet 2003;362:1527-35.

Bakris G, Burgess E, Wear M, et al. Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int. 2008;74(3):364-9.

American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes care. 2008;31:S12-S54.

Chobanian A. Bakris G. Black al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.

Ball SG, White WB. Debate: Angiotensin-converting enzyme inhibitors versus angiotensin 11 receptor blockers-A gap in evidence-based medicine. Am J Cardiol. 2003;91:15G -21G.

Ishimitsu T, Yagi S, Ebihara A, Doi Y, Domae A, Shibata A. Long term evaluation of combined antihypertensive therapy with lisinopril and a thiazide diuretic in patients with essential hypertension. Japan Heart J. 1997;38(6):831-40.

Salvetti A, Mattei P, Sudano I. Renal protection and antihypertensive drugs: Current Status. Drugs. 1999;57:665-93.

Susic D, Frohlich ED. Nephroprotective effect of antihypertensive drugs in essential hypertension. J Hypertens. 1998;16:555-67.

Bakris GL, Weir MR, DeQuattro V, McMohan FG. Effects of an ACE inhibitor/ calcium antagonist combination on proteinuria in diabetic nephropathy. Kidney Int. 1998;54(4):1283-9.