ATTEMPT-CVD: Telmisartan in the Prevention of CVD
Telmisartan, an angiotensin II receptor blocker (ARB), might have benefits over non-ARB treatment in patients with hypertension, according to results from the ATTEMPT-CVD trial presented Aug. 31 during ESC Congress 2015 in London and simultaneously published in the European Journal of Preventive Cardiology.
The study randomized more than 1,200 patients with hypertension from 168 institutions in Japan to receive telmisartan (n=615) or a non-ARB antihypertensive drug (n=613) and followed them for three years. The primary endpoints were changes from baseline in urinary albumin creatinine ratio (UACR) and plasma brain natriuretic peptide (BNP) levels. Secondary endpoints were changes in other biomarkers, including serum high-sensitivity C-reactive protein levels, urinary 8-hydroxy-deoxy-guanosine, serum adiponectin, estimated glomerular filtration rate (eGFR), and high-molecular weight adiponectin levels. Another secondary endpoint was time until occurrence of a composite of cerebral, coronary, cardiac and aortic/peripheral arterial events; complications from diabetes; and aggravation of renal function.
Overall results found that, despite similar blood pressure control in both arms, patients treated with telmisartan had a smaller increase in plasma BNP and a greater decrease in UACR than non-ARB treated patients. By 36 months, UACR had decreased by 12.2 mg/gCr in the telmisartan group compared to a decrease of 4.1 mg/gCr in the non-ARB group (P<0.001). Similarly, plasma BNP had increased by 0.5 pg/ml in the telmisartan group and by 3.8 pg/ml in the non-ARB group (P=0.044). Fewer cardiovascular events occurred in the telmisartan group, but the difference was not statistically significant.
In terms of secondary endpoints, investigators noted few variances between the two groups with other biomarkers. Only serum adiponectin, which showed a larger increase in the telmisartan group indicating better cardiovascular disease health, and eGFR, which showed a larger decrease in the telmisartan group indicating poorer renal function, were different.
"[These findings] are the first evidence that ARBs may have a better impact on two biomarkers of cardiovascular disease compared to non-ARBs," said lead investigator Hisao Ogawa, MD, FACC, from Kumamoto University, in Japan."Further study is needed to determine the significance of follow-up of BNP and UACR for cardiovascular and renal risk in hypertensive patients."
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