替米沙坦与其他抗高血压药物比较的抗炎潜能:随机试验的次要结果

IF 5.3 2区 医学 Q2 IMMUNOLOGY
Simi Bridjit Gomaz, Jaykaran Charan, Amal Mohandas, Pravesh Aggarwal, Deepak Kumar, Dharmveer Yadav, Ravindra Shukla, Sneha Ambwani, Rimple Jeet Kaur
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引用次数: 0

摘要

背景:慢性低度炎症在2型糖尿病(T2DM)和高血压的病理生理中起着核心作用,有助于增加心血管风险。替米沙坦是一种血管紧张素受体阻滞剂,具有部分过氧化物酶体增殖物激活受体γ (PPAR-γ)激动剂活性,除具有降压作用外,还具有抗炎作用。目的:本研究比较替米沙坦与其他标准降压药物对糖尿病和新诊断高血压患者炎症生物标志物的影响,包括高敏c反应蛋白(hsCRP)、白细胞介素-6 (IL-6)和肿瘤坏死因子-α (TNF-α)。方法:这是一项随机、开放标签、平行组、主动对照试验。70例符合条件的患者随机接受替米沙坦(N = 34)或另一种降压药[氨氯地平(N = 22),西尼地平(N = 12)或雷米普利(N = 2)] (N = 36)。次要结局参数包括炎症生物标志物,如在基线和治疗后12周测量的高敏感c反应蛋白(hsCRP)、白细胞介素-6 (IL-6)和肿瘤坏死因子α (TNF-α)。数据以中位数和四分位数范围(IQR)表示。12周时采用Mann-Whitney U检验进行组间比较。该试验已在印度临床试验注册中心注册(CTRI/2023/04/051878)。结果:基线时,两组间hsCRP、IL-6和TNF-α水平具有可比性。在替米沙坦组,hsCRP从3.4 mg/L (IQR: 2.0, 13.7)降至1.8 mg/L (IQR: 1.2, 5.0), IL-6从4.3 pg/mL (IQR: 2.9,9.5)降至3.4 pg/mL (IQR: 2.2, 6.8), TNF-α从19.4 pg/mL (IQR: 8.9, 43.7)降至13.8 pg/mL (IQR: 3.5, 32.4)。在活性对照组中,hsCRP从3.1 mg/L (IQR: 1.7, 8.0)变为2.9 mg/L (IQR: 1.7, 4.9), IL-6从4.1 pg/ml (IQR: 3.0,7.6)变为4.2 pg/ml (IQR: 2.9, 7.8), TNF-α从20.2 pg/ml (IQR: 10.4, 48.6)变为16.9 pg/ml (IQR: 3.3, 30.3)。12周时各组间hsCRP (P = 0.07)、IL-6 (P = 0.24)、TNF-α (P = 0.93)的差异均无统计学意义。结论:12周时两组抗炎指标均有所降低,组间差异无统计学意义。然而,替米沙坦在治疗12周后与T2DM合并高血压患者的hsCRP、IL-6和TNF-α的显著降低相关。这些发现可能表明替米沙坦具有潜在的抗炎作用,需要在足够有力的试验中得到证实。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anti-inflammatory potential of telmisartan compared to other antihypertensives: secondary outcomes from a randomized trial.

Background: Chronic low-grade inflammation plays a central role in the pathophysiology of both type 2 diabetes mellitus (T2DM) and hypertension, contributing to increased cardiovascular risk. Telmisartan, an angiotensin receptor blocker with partial peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist activity, may offer anti-inflammatory benefits in addition to its antihypertensive effects.

Aims: This study compares the effects of telmisartan versus other standard antihypertensive agents on inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), in patients with diabetes and newly diagnosed hypertension.

Methods: This is a randomized, open-label, parallel-group, active-controlled trial. Seventy eligible patients were randomized to receive telmisartan (N = 34) or another antihypertensive agent [amlodipine (n = 22), cilnidipine (n = 12), or ramipril (n = 2)] (N = 36). Secondary outcome parameters included inflammatory biomarkers such as highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-α) measured at baseline and 12 weeks following treatment. Data are presented as median and interquartile range (IQR). Between-group comparisons at 12 weeks were performed using the Mann-Whitney U test. The trial is registered with the Clinical Trial Registry of India (CTRI/2023/04/051878).

Results: At baseline, hsCRP, IL-6, and TNF-α levels were comparable between groups. In the telmisartan group, hsCRP declined from 3.4 mg/L (IQR: 2.0, 13.7) to 1.8 mg/L (IQR: 1.2, 5.0), IL-6 from 4.3 pg/mL (IQR: 2.9,9.5) to 3.4 pg/ml (IQR: 2.2, 6.8), and TNF-α from 19.4 pg/ml (IQR: 8.9, 43.7) to 13.8 pg/ml (IQR: 3.5, 32.4). In the active control group, hsCRP changed from 3.1 mg/L (IQR: 1.7, 8.0) to 2.9 mg/L (IQR: 1.7, 4.9), IL-6 from 4.1 pg/ml (IQR: 3.0,7.6) to 4.2 pg/ml (IQR: 2.9, 7.8), and TNF-α from 20.2 pg/ml (IQR: 10.4, 48.6) to 16.9 pg/ml (IQR: 3.3, 30.3). The differences between groups at 12 weeks were not statistically significant for hsCRP (P = 0.07), IL-6 (P = 0.24), or TNF-α (P = 0.93).

Conclusion: The anti-inflammatory markers were reduced in both groups at 12 weeks without any statistically significant difference across groups. However, telmisartan was associated with greater reductions in hsCRP, IL-6, and TNF-α in patients with T2DM and hypertension following 12 weeks of treatment. These findings may indicate a potential anti-inflammatory effect of telmisartan that requires confirmation in adequately powered trials.

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来源期刊
Inflammopharmacology
Inflammopharmacology IMMUNOLOGYTOXICOLOGY-TOXICOLOGY
CiteScore
8.00
自引率
3.40%
发文量
200
期刊介绍: Inflammopharmacology is the official publication of the Gastrointestinal Section of the International Union of Basic and Clinical Pharmacology (IUPHAR) and the Hungarian Experimental and Clinical Pharmacology Society (HECPS). Inflammopharmacology publishes papers on all aspects of inflammation and its pharmacological control emphasizing comparisons of (a) different inflammatory states, and (b) the actions, therapeutic efficacy and safety of drugs employed in the treatment of inflammatory conditions. The comparative aspects of the types of inflammatory conditions include gastrointestinal disease (e.g. ulcerative colitis, Crohn''s disease), parasitic diseases, toxicological manifestations of the effects of drugs and environmental agents, arthritic conditions, and inflammatory effects of injury or aging on skeletal muscle. The journal has seven main interest areas: -Drug-Disease Interactions - Conditional Pharmacology - i.e. where the condition (disease or stress state) influences the therapeutic response and side (adverse) effects from anti-inflammatory drugs. Mechanisms of drug-disease and drug disease interactions and the role of different stress states -Rheumatology - particular emphasis on methods of measurement of clinical response effects of new agents, adverse effects from anti-rheumatic drugs -Gastroenterology - with particular emphasis on animal and human models, mechanisms of mucosal inflammation and ulceration and effects of novel and established anti-ulcer, anti-inflammatory agents, or antiparasitic agents -Neuro-Inflammation and Pain - model systems, pharmacology of new analgesic agents and mechanisms of neuro-inflammation and pain -Novel drugs, natural products and nutraceuticals - and their effects on inflammatory processes, especially where there are indications of novel modes action compared with conventional drugs e.g. NSAIDs -Muscle-immune interactions during inflammation [...]
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