Irbesartan for the treatment of hypertension in patients with the metabolic syndrome: A sub analysis of the Treat to Target post authorization survey. Prospective observational, two armed study in 14,200 patients

Kintscher, Ulrich; Bramlage, Peter; Paar, W. Dieter; Thoenes, Martin; Unger, Thomas
January 2007
Cardiovascular Diabetology;2007, Vol. 6, p1
Academic Journal
Objectives: The metabolic syndrome is a cluster of cardiovascular risk factors leading to an increased risk for the subsequent development of diabetes and cardiovascular morbidity and mortality. Blocking the renin-angiotensin system has been shown to prevent cardiovascular disease and delay the onset of diabetes. Irbesartan is an angiotensin receptor blocker (ARB) which has been shown to possess peroxisome proliferator-activated receptor gamma (PPARγ) activating properties, and to have a favorable metabolic profile. Current discussion is whether the addition of small doses of hydrochlorothiazide changes this profile. Therefore the efficacy, safety and metabolic profile of Irbesartan either as monotherapy or in combination therapy was assessed in patients with the metabolic syndrome in a large observational cohort in primary care. Research design and methods: Multicenter, prospective, two-armed, post authorization study over 9 months in 14,200 patients with uncontrolled hypertension with and without the metabolic syndrome (doctors' diagnosis based on the Adult Treatment Panel III criteria 2001). Blood pressure was measured sphygmomanometrically and cardiovascular risk factors making up the criteria for the metabolic syndrome were assessed. Main outcome measures: Systolic (SBP) and diastolic (DBP) blood pressure reduction, - response, and - normalization (systolic and diastolic), changes in fasting glucose, waist circumference (abdominal obesity), serum triglycerides and HDL cholesterol as well as the proportion of patients fulfilling the criteria for the metabolic syndrome. Number and nature of adverse events (AEs). Results: After 9 month the use of Irbesartan in monotherapy resulted in a significant reduction of blood pressure (SBP: - 26.3 ± 10.1 mmHg/DBP-13.0 ± 6.6 mmHg, both p < 0.0001) in patients with the metabolic syndrome. This was accompanied by a reduction in cardiovascular risk factors: HDL cholesterol (+3.6 ± 7.2 mg/dl in men, +3.8 ± 6.5 mg/dl in women, both p < 0.0001), serum triglycerides (-28.6 ± 52.1 mg/dl, p < 0.0001), fasting blood glucose (-8.4 ± 25.1 mg/ dl, p < 0.0001) and waist circumference (-2.4 ± 11.9 cm in men, -1.2 ± 14.2 in women, both p < 0.0001) were significantly improved. Irbesartan combination therapy (12.5 mg HCTZ) in patients with the metabolic syndrome: blood pressure reduction (SBP: -27.5 ± 10.1 mmHg/DBP: -14.1 ± 6.6 mmHg, both p < 0.0001), improvement in HDL cholesterol (+4.0 ± 6.8 mg/dl in men, +3.4 ± 6.8 in women, both p < 0.0001), triglycerides (-34.1 ± 52.6 mg/dl, p < 0.0001), fasting blood glucose (-10.0 ± 24.7, p < 0.0001) and waist circumference (-3.2 ± 12.7 cm in men, -1.7 ± 14.4 in women, both p < 0.0001). Tolerability was excellent: only 0.6% of patients experienced an AE. Conclusion: There was a significant improvement in blood pressure and metabolic risk factors as a result of Irbesartan treatment. There was no evidence of a difference between monotherapy and combination therapy with regard to the cardiovascular risk profile.


Related Articles

  • Effectiveness and Tolerability of Fixed-Dose Combination Enalapril plus Nitrendipine in Hypertensive Patients. de la Sierra, Alejandro; Roca-Cusachs, Alejandro; Redón, Josep; Marín, Rafael; Luque, Manuel; de la Figuera, Mariano; Garcia-Garcia, Margarida; Falkon, Liliana // Clinical Drug Investigation;2009, Vol. 29 Issue 7, p459 

    Background and objective: Monotherapy with any class of antihypertensive drug effectively controls blood pressure (BP) in only about 50% of patients. Consequently, the majority of patients with hypertension require combined therapy with two or more medications. This study aimed to evaluate the...

  • Control of hypertension in diabetes. Bain, Steve; Samat, Ashish // GP: General Practitioner;8/18/2006, p22 

    The article discusses the effective control of blood pressure (BP) in the patients of diabetes. Researchers say that patients with type-1 diabetes are vulnerable to hypertension. To prevent any emergency, it is advised that BP readings should be taken over three to six months before considering...

  • Why don't diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification. Schmittdiel, Julie A.; Uratsu, Connie S.; Karter, Andrew J.; Heisler, Michele; Subramanian, Usha; Mangione, Carol M.; Selby, Joe V. // JGIM: Journal of General Internal Medicine;May2008, Vol. 23 Issue 5, p588 

    Background: Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved.Objective: To examine the relative...

  • Amelioration of Endothelial Dysfunction Associated with Diabetes Mellitus and Hypertension by Etoricoxib, Lornoxicam and Allopurinol. Nade, V. S.; Kawale, L. A.; Deshmukh, P. S.; Zambare, S. S.; Wale, Y. B. // International Journal of Pharmaceutical Sciences & Drug Research;Apr-Jun2014, Vol. 6 Issue 2, p132 

    Endothelial dysfunction is associated with diabetes mellitus and hypertension. Oxidative stress and augmented activity of associated enzymes like cyclooxygenase (COX) and xanthine oxidase (XO) is a major culprit. In this study, diabetes mellitus (DM) was induced by alloxan (75 mg/kg, i.v) and...

  • SOCIALLY SIGNIFICANT DISEASES AND THEIR FREQUENCY IN GENERAL MEDICINE. Alekova, S.; Slavova, V.; Platikanova, M.; Parashkevova, B. // Trakia Journal of Sciences;2010 Supplement 2, Vol. 8, p369 

    Arterial hypertension, diabetes, chronic obstructive pulmonary disease and neoplastic processes are most important national priorities, which the Bulgarian healthcare must cope. Decisive role in the prevention, diagnosis, treatment and monitoring of socially significant diseases have family...

  • Prevention of the progression of chronic kidney disease: Practice in China. Haiyan Wang; Luxia Zhang; Jicheng Lv // Kidney International Supplement;Apr2005, Issue 94, p63 

    Prevention of the progression of chronic kidney disease: Practice in China. With the epidemic rise of end-stage renal disease (ESRD) in many countries of the world, there is an urgent need to develop and implement strategies aiming at preventing the development and progression of chronic kidney...

  • Chlorthalidone Improves Endothelial-Mediated Vascular Responses in Hypertension Complicated by Nondiabetic Metabolic Syndrome.  // Journal of Cardiovascular Pharmacology & Therapeutics;Dec2005, Vol. 10 Issue 4, p265 

    The article focuses on a study that examined the vascular effects of chlorthalidone, a distal tubule-acting natriuretic agent, in hypertensive patients with nondiabetic metabolic syndrome, an insulin-resistant condition that is characterized by endothelial dysfunction and high risk for diabetes...

  • Increased plasma soluble endoglin levels as an indicator of cardiovascular alterations in hypertensive and diabetic patients. Blázquez-Medela, Ana M.; García-Ortiz, Luis; Gómez-Marcos, Manuel A.; Recio-Rodríguez, José I.; Sánchez-Rodríguez, Angel; López-Novoa, José M.; Martínez-Salgado, Carlos // BMC Medicine;2010, Vol. 8, p86 

    Background: Endoglin is involved in the regulation of endothelial function, but there are no studies concerning its relation with hypertension- and diabetes-associated pathologies. Thus, we studied the relationship between plasma levels of soluble endoglin and cardiovascular alterations...

  • Aiming at a moving target. Sayburn, Anna // Update;9/24/2004, Vol. 69 Issue 4, p101 

    This article presents information about hypertension patients. Hypertension targets are now so low as to be unachievable for most ; patients, especially older people and those with diabetes. That was the stark claim of two general practice lecturers from the University of Aberdeen in the British...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics