Effect of 24-Week Treatment with Telmisartan on Myocardial Structure and Function: Relationship to Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene

Effect of telmisartan on the expression of cardiac adiponectin and its receptor 1 in type 2 diabetic rats

OBJECTIVES

This study investigated the effect of telmisartan on the expression of cardiac adiponectin and its receptor 1 in type 2 diabetic rats.

METHODS

Thirty-six male Wistar rats were randomly divided into control (C, n = 10) and diabetic (n = 26) groups. Type 2 diabetes was induced by high-fat and high-sugar diet and intraperitoneal injection of a low dose of streptozotocin (STZ). After induction of diabetes, diabetic rats were again randomly divided into diabetic (D, n = 10) and diabetic treated (DT, n = 10) groups. Telmisartan (5 mg/kg/day) was administrated to diabetic treated rats by gavage for 12 weeks. Twelve weeks later, the heart function was investigated. Plasma and myocardial adiponectin levels were detected by enzyme-linked immunosorbent assay (ELISA). The cardiac mRNA expression of adiponectin receptor 1 (adipiR1) was assayed by reverse transcript-polymerase chain reaction (RT-PCR). The cardiac protein expression of adipiR1, AMP-activated protein kinase (AMPK)-α, phospho-AMPK-α (Thr172) and glucose transporter 4(GLUT4) was determined by Western blotting.

KEY FINDINGS

The ratio of heart weight to body weight was significantly increased in diabetic rats compared with control. The decreased levels of plasma and myocardial adiponectin and the decreased protein and mRNA expression of myocardial adipoR1 led to the decreased myocardial phosphorylation of AMPK-α (Thr172) and the decreased protein expression of myocardial GLUT4 in diabetic rats. Consequently, the heart function was decreased in diabetic rats. Telmisartan treatment significantly attenuated the increased ratio of heart weight to body weight in diabetic rats. The levels of plasma and myocardial adiponectin and the expression of myocardial adipoR1 in diabetic rats were upregulated by telmisartan. Subsequently, the levels of myocardial phospho-AMPK-α (Thr172) and the expression of myocardial GLUT4 in diabetic rats were increased by telmisartan. Consequently, the heart function was improved in diabetic rats treated with telmisartan.

CONCLUSIONS

These results suggest that the levels of myocardial adiponectin and its receptor 1 are decreased in type 2 diabetic rats. Telmisartan treatment up-regulates the levels of myocardial adiponectin and its receptor 1, resulting in the increase in myocardial phospho-AMPK-α (Thr172) and GLUT4 expression, which may contribute to the improvement of heart function and the decrease in cardiac hypertrophy in diabetic rats.

Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension

The development of angiotensin II receptor blockers (ARB) as a new class of drugs for the management of hypertension has elicited the attention of many clinicians worldwide with the aim of improving blood pressure (BP) control as well as cardiovascular protection.AmongARB telmisartan has been shown to be characterised by an antihypertensive efficacy fully covering the 24-hour period, thereby allowing to antagonise the adverse effects of early morning BP rise on cardiovascular risk. Other specific effects of the drug are represented by its favourable metabolic profile (particularly on insulin sensitivity) and neutral effects on sympathetic cardiovascular function.These properties are coupled with cardioprotective effects, documented by the evidence that the drug: 1) is effective in favouring the regression of cardiac and vascular organ damage, 2) reduces arterial stiffness and improves vascular distensibility and 3) reverses the endothelial dysfunction typical of the hypertensive state particularly when complicated by renal failure, diabetes, obesity or metabolic syndrome. Several of these properties can account for the results of the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), documenting the beneficial effects on the drug on cardiovascular morbidity and mortality.

Effective treatment of hypertension by AT(1) receptor antagonism: the past and future of telmisartan

Lowering blood pressure is the most effective treatment method to ensure a reduction in the total risk for cardiovascular morbidity and mortality. The renin-angiotensin system plays an important role in volume homeostasis and blood pressure regulation and is a target for several groups of pharmaceutical agents. Angiotensin II receptor blockers represent the newest class of antihypertensive compounds. They prevent the binding of angiotensin II to the subtype 1 receptor (AT(1)), which is believed to mediate most of the physiological actions relevant to the regulation of blood pressure. Telmisartan, a widely used AT(1) receptor antagonist, is a highly selective compound with high potency, a long duration of action and a tolerability profile similar to placebo. Numerous randomized clinical trials and community-based studies have demonstrated that oral telmisartan and combinations of telmisartan with hydrochlorothiazide are at least as effective in lowering blood pressure as all other hypertensive medications. This has been demonstrated in different populations of adult patients with mild-to-moderate essential hypertension, including patients with coexisting Type 2 diabetes, metabolic syndrome or renal impairment. Several large-scale, long-term, clinical endpoint studies are in progress to assess the beneficial effects of telmisartan on hypertension-related end-organ damage in patients at high risk of renal, cardiac and vascular damage whose blood pressure is well controlled. The most recent data from clinical trials and latest research regarding telmisartan will be reviewed in this article.