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Micardis(R) - Micardis Plus(R) - Effekte bei Zielorganschädigung (16 Abbildungen)




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FÜR ÖSTERREICH: Weitere Informationen: Merck Gesellschaft mbH, Zimbagasse 5, 1147 Wien, Tel.: 01/576 00-0
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Effekte bei Zielorganschädigung
Abbildung 1


 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 2: The Telmisartan versus Ramipril in renal ENdothelial DYsfunction (TRENDY) study showed that telmisartan improves endothelial function in the kidneys of patients with type 2 diabetes, good renal function and low or absent microalbuminuria [1]. The 96 patients had mild-to-moderate hypertension (seated SBP/DBP 140–180/90–110 mmHg), normo- or microalbuminuria and GFR > 80 mL/min/1.73 m2. They received telmisartan 40 mg or ramipril 5 mg for 3 weeks, followed by telmisartan 80 mg or ramipril 10 mg for 6 weeks, with add-on therapy (HCTZ, metoprolol or atenolol) to ensure blood pressure control. Endothelial function was assessed by measuring renal plasma flow in response to the infusion of N(G)-monomethyl-L-arginine acetate (L-NMMA). The percentage change from baseline in endothelial function is shown in this slide. 1. Schmeider RE, et al. Effects of telmisartan versus ramipril on renal endothelial function in Type-2 diabetes. Presented at the XVIth Scientific Meeting of the Interamerican Society of Hypertension. Cancún, México, April 17–21, 2005.


Keywords: DiagrammEndothelTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 3: The TRENDY study also compared renal plasma flow and renal vascular resistance at rest (i.e. without stimulation by infusion of L-NMMA).1 Telmisartan significantly improved renal plasma flow and decreased vascular resistance. Ramipril did not significantly change these parameters. 1. Schmeider RE, et al. Effects of telmisartan versus ramipril on renal endothelial function in Type-2 diabetes. Presented at the XVIth Scientific Meeting of the Interamerican Society of Hypertension. Cancún, México, April 17–21, 2005.


Keywords: DiagrammGefäßwiderstandNierenplasmastromTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 4: Patients in the TRENDY study had low levels of albuminuria at baseline.1 Despite this, telmisartan still produced a significant reduction in albuminuria, whereas ramipril did not. 1. Schmeider RE, et al. Effects of telmisartan versus ramipril on renal endothelial function in Type-2 diabetes. Presented at the XVIth Scientific Meeting of the Interamerican Society of Hypertension. Cancún, México, April 17–21, 2005.


Keywords: AlbuminurieDiagrammTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 5: Redón et al. conducted a 12-month study to assess the interactions between RAAS gene polymorphisms and telmisartan therapy in patients with mild-to-moderate hypertension.1 There was no correlation between RAAS gene polymorphisms and the response to telmisartan. Of the 206 patients, 28% had microalbuminuria (urinary albumin excretion [UAE] >30 mg/day), and mean UAE was 32.7 mg/day. After 3 months, telmisartan significantly reduced albuminuria by 52%, and this was reduced further to a 69% reduction by the end of the study. 1. Redón J, et al. Renin-angiotensin system gene polymorphisms: relationship with blood pressure and microalbuminuria in telmisartan-treated hypertensive patients. Pharmacogenomics J 2005; 5: 14–20.


Keywords: DiagrammHypertonieMikroalbuminurieTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 6: Ucak et al. conducted an open-label study comparing lisinopril 20 mg as monotherapy and in combination with telmisartan 80 mg in 100 type 2 diabetics with microalbuminuria (30–300 mg/24 h) who had been receiving ACE inhibitors for at least 6 months previously.1 At baseline, albuminuria was 264 mg/24 h in the lisinopril group and 256 mg/24 h in the combination therapy group. After 12 months, albuminuria had decreased to 186 mg/24 h with lisinopril and 144 mg/24 h with combination therapy (P<0.001). Both treatment arms had a similar decrease in blood pressure (SBP/DBP decreased by 1/2 and 1/4 mmHg in the lisinopril monotherapy and lisinopril/telmisartan combination therapy, respectively). 1. Ucak S, et al. Combination of telmisartan and ACE-I significantly reduces urinary albumin excretion in hypertensive patients with type 2 diabetes. Program and abstracts of the 38th Annual Meeting of the European Association for the Study of Diabetes Budapest, Hungary: September 1–5, 2002.


Keywords: ACE-HemmerAlbuminurieDiagrammTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 7: The Diabetics Exposed to Telmisartan And enalaprIL (DETAIL) study assessed the decline in renal function over 5 years in 250 patients with type 2 diabetes, mild-to-moderate hypertension, and GFR that was either normal or only mildly impaired.1 It employed a 1-month run-in period, followed by up-titration over a period of 1 month to either telmisartan 80 mg or enalapril 20 mg. Add-on antihypertensive therapy (- or -blocker, CCB, diuretic) was allowed after 2 months of double-blind treatment if seated DBP was >100 mmHg or SBP was >160 mmHg. There were no significant differences in GFR at 5 years, or in the change in GFR over 5 years. At endpoint, the difference (telmisartan minus enalapril) in GFR was –3.0 ml/min/1.73 m2, with 95% confidence interval –7.6 to +1.6. Telmisartan was comparable to enalapril (i.e. met the statistical test for non-inferiority), since the 95% confidence interval of the difference was <–10 mL/min/1.73 m2. 1. Barnett A, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952–1961.


Keywords: DiagrammGFRglomeruläre FiltrationsrateTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 8: In DETAIL, the steepest decline in GFR was seen in the first year.1 This was probably a haemodynamic effect, associated with the lowering of systemic blood pressure that results in reduced intraglomerular pressure.2 Thereafter, the rate of decline was markedly reduced with a consistent, year-on-year effect. The mean decline in GFR of patients in the telmisartan group was 3.7 ml/min/1.73 m2/year in those who completed the study, and 3.6 ml/min/1.73 m2/year in the LOCF dataset. In the enalapril group, the mean rate of GFR decline was 3.3 ml/min/1.73 m2/year in those who completed the study, and 3.1 ml/min/1.73 m2/year in the last observation carried forward dataset. 1. Barnett A, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952–1961. 2. Levey AS, et al. Short-term effects of protein intake, blood pressure, and antihypertensive therapy on glomerular filtration rate in the Modification of Diet in Renal Disease Study. J Am Soc Nephrol 1996; 7: 2097–2109.


Keywords: DiagrammGFRglomeruläre FiltrationsrateTelmisartan
 
 
Telmisartan - Renoprotektiver Effekt
Abbildung 9: If diabetic nephropathy is left untreated, GFR declines steadily by 10–12 ml/min/1.73 m2/year.1 In DETAIL, GFR declined over 5 years by 17.9 ml/min/1.73m2 in the LOCF dataset and 18.7 ml/min/1.73 m2 in completers. The rate of decline slowed over time.2 Thus treatment with telmisartan halted the progression of diabetic nephropathy. 1. Parving H-H, et al. Angiotensin receptor blockers in diabetic nephropathy: renal and cardiovascular endpoints. Semin Nephrol 2004; 24: 147–151. 2. Barnett A, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952–1961.


Keywords: DiagrammGFRglomeruläre FiltrationsrateTelmisartan
 
 
Telmisartan - LVH
Abbildung 10: This clinical study assessed the effect of 12 months’ treatment with telmisartan 40–80 mg on left ventricular mass index (LVMI) in 90 patients with hypertension and echocardiographic evidence of mild-to-moderate LVH.1 Mean SBP was reduced from 167 mmHg at baseline to 126 mmHg at treatment end (p<0.001) and mean DBP from 104 mmHg to 86 mmHg (p<0.001). There was a concomitant decrease in LVMI, from 121 ± 7 g/m2 at baseline to 109 ± 3 g/m2 at treatment end (p<0.01). Mattioli AV, et al. Regression of left ventricular hypertrophy and improvement of diastolic function in hypertensive patients treated with telmisartan. Int J Cardiol 2004;97:383–388.


Keywords: Diagrammlinksventrikulärer MasseindexLVHTelmisartan
 
 
Telmisartan - LVH
Abbildung 11: This study used a freehand three-dimensional echocardiographic technique to evaluate the effect of telmisartan on left ventricular mass (LVM).1 The technique employs a magnetic sensor attached to an ultrasound probe to aid spatial location, which enables calculation of LVM without geometric assumptions. In this multicentre, randomized, double-blind study, 65 patients with hypertension received 12 months of treatment with either telmisartan 80 mg (n=40) or HCTZ 25 mg (n=25). Both drugs lowered blood pressure significantly: mean 24-h ambulatory SBP/DBP was reduced from baseline by 24/13 mmHg with telmisartan and by 10/8 mmHg with HCTZ. There was also a significant 16 g/m2 decrease in LVMI (from 141 ± 16 g/m2 to 125 ± 19 g/m2; p<0.02) in the telmisartan treatment group. However, the 4 g/m2 reduction in LVMI (from 139 ± 20 g/m2 to 135 ± 22 g/m2) observed in the HCTZ group was not statistically significant. Galzerano D, et al. Freehand three-dimensional echocardiographic assessment of efficacy of telmisartan on left ventricular mass in hypertensive patients: a multicentre study. J Hum Hypertens 2004; 18: 53–59.


Keywords: DiagrammHCTZLVHTelmisartan
 
 
Telmisartan - LVH
Abbildung 12: Telmisartan reduced LVH compared with carvedilol despite similar reductions in blood pressure.1 The 84 patients in this study had hypertension and LVH, and received telmisartan 80 mg or carvedilol 25 mg for 44 weeks. LVM was measured by MRI (results shown in this slide) and three-dimensional echocardiography. Both treatments reduced 24-h mean SBP/DBP by similar amounts (telmisartan by 31/19 mmHg, carvedilol by 29/17 mmHg, P=ns). However, telmisartan reduced LVM significantly more than did carvedilol. Similar effects were seen using echocardiography. Galzerano D, et al. Three-dimensional echocardiographic and magnetic resonance assessment of the effect of telmisartan compared to carvedilol on left ventricular mass: a multicenter randomized study. 53rd Annual Scientific Session of the American College of Cardiology, 2004, New Orleans, USA. 2004.


Keywords: CarvedilolDiagrammLVHTelmisartan
 
 
Telmisartan - LVH
Abbildung 13: This clinical study assessed the effect of 12 months’ treatment with telmisartan 40–80 mg on LVMI in 90 patients with hypertension and echocardiographic evidence of mild-to-moderate LVH.1 There was a significant improvement in diastolic filling: the early to atrial filling ratio increased from 0.59 ± 0.2 at baseline to 0.88 ± 0.2 at study end (P<0.05). 1. Mattioli AV, Zennaro M, Bonatti S, Bonetti L, Mattioli G. Regression of left ventricular hypertrophy and improvement of diastolic function in hypertensive patients treated with telmisartan. Int J Cardiol 2004; 97: 383–388.


Keywords: Diagrammdiastolische FunktionLVHTelmisartan
 
 
Telmisartan - Arterienelastizität
Abbildung 14: Arterial stiffness is an independent risk factor for cardiovascular mortality.1 Pulse wave velocity increases as vascular stiffness increases, and can cause increased SBP. In this study, 28 patients with type 2 diabetes and mild-to-moderate hypertension were given placebo or telmisartan 40 mg for 3 weeks in a cross-over design with 2-week placebo wash-out.2 Telmisartan significantly reduced pulse wave velocity along the carotid-femoral route, with improvements along the carotid-radial route approaching significance. 1. Laurent S, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236–1241. 2. Asmar R, et al. Effects of telmisartan on arterial stiffness in Type 2 diabetes patients with essential hypertension. J Renin Angiotensin Aldosterone Syst 2002; 3: 176–180.


Keywords: ArterieDiabetes mellitus Typ 2DiagrammElastizitätHypertonieTelmisartan
 
 
Telmisartan - Arterienelastizität
Abbildung 15: In this study, 24 patients with hypertension received telmisartan 40 mg/day for 3 months.1 Brachial-ankle pulse wave velocity (ba-PWV) was significantly reduced. Office blood pressure was also reduced. However, the improvement in ba-PWV was greater than predicted on the basis of blood pressure changes. 1. Uchida H, et al. Practical efficacy of telmisartan for decreasing morning home blood pressure and pulse wave velocity in patients with mild-to-moderate hypertension. Hypertens Res 2004; 27: 545–550.


Keywords: ArterieDiagrammElastizitätHypertonieTelmisartan
 
 
Effekte bei Zielorganschädigung
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