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Effects of high-intensity statin combined with telmisartan versus amlodipine on glucose metabolism in hypertensive atherosclerotic cardiovascular disease patients with impaired fasting glucose: A randomized multicenter trial

Authors
 Chan Joo Lee  ;  Jung-Hoon Sung  ;  Tae-Soo Kang  ;  Sungha Park  ;  Sang-Hak Lee  ;  Jong-Youn Kim  ;  Byeong-Kuek Kim 
Citation
 MEDICINE, Vol.101(36) : e30496, 2022-09 
Journal Title
MEDICINE
ISSN
 0025-7974 
Issue Date
2022-09
MeSH
Amlodipine / therapeutic use ; Atherosclerosis* / complications ; Cardiovascular Diseases* / complications ; Fasting ; Glucose ; Heart Diseases* / complications ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects ; Hypertension* / chemically induced ; Hypertension* / complications ; Hypertension* / drug therapy ; Insulin Resistance* ; Prediabetic State* / complications ; Rosuvastatin Calcium ; Telmisartan / therapeutic use
Abstract
Background: There is lacking evidence that telmisartan can improve insulin resistance in patients on high-intensity statins. This study compared the effects of telmisartan and amlodipine on glucose metabolism in hypertensive atherosclerotic cardiovascular disease (ASCVD) patients with impaired fasting glucose (IFG) requiring high-intensity rosuvastatin therapy.

Methods: Ninety-nine patients were randomly assigned to 2 groups [telmisartan-statin group (n=48) and amlodipine-statin group (n=51)] as add-on therapy to high-intensity rosuvastatin therapy (20 mg). The primary endpoint was to assess insulin resistance using the homeostatic model assessment (HOMA-IR) value at week 24. The secondary endpoint was the change in glucose metabolism indices from baseline to week 24.

Results: The HOMA-IR at week 24 (2.4 [interquartile range, 1.8-3.8] versus 2.7 [1.7-3.7]; P = .809) and changes in the HOMA-IR from baseline to week 24 (-7.0 [-29.0 to 21.0] versus -5.5 [-53.3 to 27.3]; P = .539) were not significantly different between 2 groups. However, the fasting glucose level at week 24 was significantly lower in the telmisartan-statin group than in the amlodipine-statin group (107.7 ± 13.4 mg/dL versus 113.3 ± 12.4 mg/dL; P = .039) and significantly decreased in the telmisartan-statin group (-3.2 ± 8.6% versus 3.8 ± 13.2%; P = .003). The proportion of patients with fasting glucose ≥100 mg/dL (71.1% versus 89.6%; P = .047) or new-onset diabetes mellitus (12.5% versus 31.4%, P = .044) at week 24 was also significantly lower in the telmisartan-statin group than in the amlodipine-statin group.

Conclusion: In comparison to amlodipine, telmisartan did not decrease the HOMA-IR. However, telmisartan preserved insulin secretion, led to a regression from IFG to euglycemia and prevented new-onset diabetes mellitus in ASCVD patients with IFG requiring high-intensity statins.
Files in This Item:
T202204748.pdf Download
DOI
10.1097/MD.0000000000030496
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Lee, Sang Hak(이상학) ORCID logo https://orcid.org/0000-0002-4535-3745
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192078
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