Abstract 3670: Effects of Telmisartan, Angiotensin II Receptor Blocker, on Endothelial Function and Aortic Stiffness in Morning Hypertensive Patients with the Metabolic Syndrome and Obstructive Sleep Apnea
Morning hypertension and the metabolic syndrome (MetS) are recognized as a risk factor for cardiovascular disease, and are reported to be associated with obstructive sleep apnea (OSA). Recently it has been reported that telmisartan has an action of PPAR - γ agonist. We assessed the effects of telmisartan on endothelial function and aortic stiffness in morning hypertensive patients with MetS and OSA. Thirty untreated morning hypertensive patients with MetS and mild or moderate OSA (an apnea-hypopnea index [AHI] 5 – 30) were randomized to receive telmisartan (Telmisartan group, 20 - 40 mg/day, n=15) or amlodipine (Amlodipine group, 2.5 - 5 mg/day, n=15). Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of brachial artery were measured by using ultrasound system. Pulse wave velocity (PWV) was measured by using oscilometric technique. We assessed insulin resistance by HOMA-IR, and measured high sensitivity C-reactive peptide (hsCRP) and thiobarbituric acid reactive substance (TBARS) as indexes of inflammation and oxidative stress. Measurements were performed at baseline, and then at 6 and 12 months after the treatments. Office blood pressure was significantly decreased in the both groups, and there was no difference between two groups at baseline, 6 months and 12 months. Morning blood pressure was also significantly decreased in the both groups, however, it was much lower in the telmisartan group at 12 months. FMD was significantly increased, and PWV, HOMA-IR, hsCRP, and TBARS were significantly decreased in the both groups. However, these improvements were much better in the telmisartan group as compared with the amlodipine group at 6 and 12 months. NID did not change during this study. Telmisartan improves not only endothelial function and aortic stiffness, but also insulin resistance, inflammation, and oxidative stress in morning hypertensive patients with MetS and OSA.