A Comparative Safety and Efficacy Study of Olmesrtan, a Newer Angiotensin-II Type-1 Receptor Blocker in Early Stage Type–2 Diabetes with Hypertension

Enugula Vijay Kumar*, Shaik Mohammed Yusuf, M. Vara Prsanna Rao, B. Nagendra Prasad, C. Surya Savarny
Srinivasa Institute of Pharmaceutical Sciences, Proddatur, YSR Kadapa, Andhra Pradesh, India

A B S T R A C T
Patients with type-2 diabetes are at high risk for developing cardiovascular diseases, which are also the most common cause of death in these patients. Angiotensin II type-1 receptor blockers (ARB) are widely used for the treatment of hypertension. Among the several ARBs available in the clinical setting, olmesartan is thought to have a significantly stronger blood pressure lowering effect than losartan or valsartan with their respective starting doses. In addition, recent data demonstrated that olmesartan more adequately achieved ambulatory blood pressure monitoring (ABPM) goals during the early morning surge period than did candesartan. Considering the importance of strict blood pressure control, olmesartan offers certain advantages in clinical use. With regard to its metabolic effect, telmisartan has the unique property of selective peroxisome proliferation–activated receptor (PPARγ) modulating activity, at least in-vitro. Thus, telmisartan might have clinical effects similar to those of PPARγ agonists, such as improving insulin resistance and increasing serum adiponectin levels. In fact, a recent study demonstrated that replacement of valsartan with telmisartan reduced serum highly sensitive C-reactive protein (hs-CRP) and increased serum adiponectin. Another study revealed that telmisartan has superior effects on metabolic parameters compared to losartan in hypertensive patients with metabolic syndrome. In addition, telmisartan blood pressure lowering effect is reported to last longer than valsartan’s. To gain insight into the respective properties of ARB for type-2 diabetic patients with hypertension, an open-label crossover trial was conducted to compare the efficacy of the starting doses of olmesartan and telmisartan on blood pressure, and metabolic parameters. A clinical study has shown that a doses in patients with type-2 diabetes, olmesartan seems to have more potent blood pressure lowering than telmisartan, but similar effects on metabolic parameters. Our results suggest that olmesartan can be considered an ideal agent to prevent future onset of cardiovascular disease in type-2 diabetic patients with hypertension.
Keywords: cardiovascular, diseases, Angiotensin II, olmesartan, telmisartan, hypertension.