20 Aug The angiotensin II receptor antagonist telmisartan reduces rinary albumin excretion in patients with isolated systolic hypertension: results of a randomized, double-blind, placebo-controlled trial.
Liffert Vogta, Gerjan Navisa, Ju¨ rgen Ko¨ sterb, Athanasios J. Manolisc, John L. Reidd, Dick de Zeeuwa and on behalf of the Angiotensin II Receptor Antagonist Telmisartan Micardis in Isolated Systolic Hypertension (ARAMIS) Study Group
Objective: To examine the effect of telmisartan or hydrochlorothiazide on the control of urinary albumin excretion (UAE) in patients with isolated systolic hypertension (ISH) unselected for albuminuria in a pre-planned substudy of a large, multicentre, double-blind, placebo-controlled, randomized study.
Methods: The Angiotensin II Receptor Antagonist Micardis in Isolated Systolic hypertension (ARAMIS) study compared the antihypertensive efficacy after 6 weeks of once-daily fixed doses of telmisartan 20, 40 or 80 mg versus hydrochlorothiazide 12.5 mg or placebo in patients (n U 1039, aged 35–84 years) with ISH (seated blood pressure 150–179/< 90 mmHg). The prospective substudy analysed UAE using spot morning samples.
Results: Urinary albumin (> 2.2–901.6 mg/l) was detected at baseline in 614 out of 918 patients who were included in the substudy analysis. In the telmisartan group (n U 354, all doses combined), a median reduction in UAE from a baseline of 14.1% [95% confidence interval (CI) 7.3, 21.8] was observed versus 1.1% (95% CI S13.5 to 16.0) and 2.7% (95 CI S0.9 to 19.9) in the hydrochlorothiazide (n U 140) and placebo (n U 120) groups, respectively. The difference between telmisartan and hydrochlorothiazide was significant (P U 0.017). Reductions in UAE with telmisartan were observed in patients with baseline normoalbuminuria, microalbuminuria or macroalbuminuria. Telmisartan and hydrochlorothiazide produced
Isolated systolic hypertension (ISH) is an important treatment target, recognized as a dominant risk factor for heart disease, stroke and renal failure [1,2]. Microalbuminuria and macroalbuminuria are also widely accepted risk factors for cardiovascular and renal disease in patients with diabetes [3,4] and hypertension [5–7]. In comparable reductions in systolic blood pressure in these patients.
Conclusion: In patients with ISH unselected for baseline albuminuria, telmisartan 20–80 mg after 6 weeks’ treatment afforded significantly greater lowering of UAE than hydrochlorothiazide 12.5 mg, irrespective of the baseline UAE, and despite comparable reductions in systolic blood pressure with both drugs. J Hypertens 23:2055–2061 Q
2005 Lippincott Williams & Wilkins.
Journal of Hypertension 2005, 23:2055–2061
Keywords: albuminuria, angiotensin II receptor antagonist, cardiovascular and renal risk, isolated systolic hypertension