PROTECTIVE EFFECT OF TELMISARTAN AGAINST ENDOTHELIAL DYSFUNCTION AFTER CORONARY DRUG-ELUTING STENT IMPLANTATION IN HYPERTENSIVE PATIENTS


Mitsuyasu Terashima, M.D., Toyohashi, Japan

Objectives: The aim of this prospective, randomized study was to evaluate the effects of telmisartan on endothelial function after coronary drug-eluting stent (DES) implantation in hypertensive patients, compared to a calcium channel blocker, amlodipine.

Background: DES implantation impairs local endothelial function, which may be associated with future cardiovascular events. Telmisartan, which has unique proliferator- activated-receptor-gamma mediated effects in addition to its renin-angiotensin system inhibition effects, has favorable effects on endothelial function.

Methods: Fifty-one hypertensive patients with coronary artery stenosis but without coronary artery spasm, treated with a sirolimus-eluting stent, were randomly assigned to either the telmisartan (25 cases) or amlodipine (26 cases) treatment group. At baseline and at 3 months after DES implantation, endothelium-dependent and –independent vasomotion were evaluated by quantitative coronary angiography under the condition of medication withdrawal. The mean luminal diameter of a 20-mm coronary segment, beginning 5 mm distal to the stent, was measured before and after infusion of intracoronary acetylcholine (ACh: 10-7 mol/L, 10-6 mol/L) and then again after infusion of nitroglycerin.

Results: Blood pressure was comparable between groups at baseline and after 3 months. Vasoconstriction after ACh infusion at 3 months (impaired endothelial function) was less pronounced in the telmisartan-group than in the amlodipine-group (p<0.0001), although there was no significant difference between the two groups before DES implantation. The response to nitroglycerin did not differ between groups before or at 3 months after DES implantation.

Conclusions: Telmisartan significantly ameliorated endothelial dysfunction after DES implantation in terms of vasoconstriction induced by ACh compared to amlodipine.