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
Introduction
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