Abstract 10727: Telmisartan Reduces Coronary Plaque Vulnerability and Instent-neointimal Proliferation in Hypertensive Patients
Background: The effects of telmisartan on the coronary plaque component, inflammatory cytokines, and neointimal reaction are not known, while the pleiotropic effect of that has been well studied.
Methods: A total of 40 hypertensive patients with stable angina planned to be treated with bare metal stent (BMS) were randomized to two groups: the telmisartan group (additional treatment with telmisartan [80mg/day, n=20]) or the control group (additional treatment with other antihypertensive drugs except renin-angiotensin system blockers, n=20) for six months. Tissue characteristics of target coronary plaque, which had to be more than 5 mm from the intervention site, were analyzed using integrated backscatter intravascular ultrasound (IB-IVUS) before and after treatment. We also measured plasma levels of inflammatory cytokines sampled in the coronary sinus (CS).
Results: Significant increases in fibrous volume (51.3±10.4 to 58.3±7.7%, p=0.03) and reductions in lipid volume (38.5±12.4 to 32.8±9.7%, p=0.03) were observed on IB image analyses in the telmisartan group, while there were no significant changes in the plaque component in the control group. CS-levels of inflammatory cytokines [matrix metalloproteinase-3 (MMP3), tumor necrosis factor α (TNFα), high-sensitive C-reactive protein (hsCRP) and matrix metalloproteinase-9 (MMP9)] were smaller after than before treatment in the telmisartan group (7.6±6.1 to 5.5±4.9 ng/ml, 3.1±1.9 to 2.4±2.0 pg/ml, 5.6±6.0 to 2.2±2.4 mg/l, 36.1±39.3 to 19.8±27.5 ng/ml, p=0.03, p=0.04, p=0.07, p=0.19, respectively), however, there were no significant changes in cytokine levels between baseline and follow-up in the control group. Percent diameter stenosis at 6 months was significantly lower in the telmisartan group than in the control group (33.6±21.4 vs 50.4±25.1%, p=0.04), however, there were no significant differences in binary restenosis rate (20.0 vs 45.0%, p=0.10).
Conclusions: Plaque stabilization on IB image analyses, decreased local inflammatory response, and suppressed instent-neointimal proliferation were observed after six months of telmisartan treatment. These findings may be associated with local anti-inflammatory and anti-arteriosclerotic effects of telmisartan.
- © 2012 by American Heart Association, Inc.