Two Meds to Guard the Diabetic Heart

Diabetes patients may lower risk of heart disease with either of two blood pressure medications

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) High blood pressure is twice as likely to strike a person with diabetes than without. While several medications are commonly used to control blood pressure, two may have extra benefits for the heart of diabetes patients.

Scientists recently found that telmisartan and valsartan, a type of medication, were linked with a lower risk of hospitalization for heart attack, stroke or heart failure compared with other similar medications.

All angiotensin-receptor blockers inhibit a hormone called angiotensin, which causes blood vessels to narrow, and are linked with various health conditions. 

"Ask a pharmacist how to treat high blood pressure."

Tony Antoniou, MD, in the Department of Family and Community Medicine at St. Michael’s Hospital in Toronto, and his colleagues looked at data from 54,186 patients with diabetes taking angiotensin-receptor blockers over a nine-year period.

All the patients were over the age of 65 and residents of Ontario, Canada.

Angiotensin-receptor blockers such as telmisartan (brand name Micardis), valsartan (Diovan), candesartan (Atacand), irbesartan (Avapro) and losartan (Cozaar) relax and widen vessels, improving blood flow and lowering pressure. They also help blood pressure by increasing the release of sodium and water to urine.

Dr. Antoniou and co-authors set out to find which of these blood pressure medications lowered the risk of heart disease in diabetes patients.

Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes, according to the American Diabetes Association.

Compared with other angiotensin-receptor blockers, telmisartan and valsartan were both linked with a lower risk of admission to hospital for heart attack, stroke or heart failure among older adults with diabetes and high blood pressure, according to this study.

The authors found, "important pharmacologic differences exist between the drugs that may explain our results."

The scientists wrote, "telmisartan is unique among these drugs in its ability to structurally interact with and activate the PPARg receptor."

Peroxisome proliferator-activated (PPA) receptors are located inside many cells throughout the body. Stimulation of these receptors activates different genes, and results in the control of the body’s metabolism and growth.

For diabetes patients, telmisartan’s interaction with PPARg improves insulin sensitivity, according to the researchers.

Dr. Antoniou and his team also highlighted that "telmisartan was associated with a lower risk of admission to hospital for heart failure when compared with irbesartan."

The authors suggested that randomized controlled trials and large observational studies looking at cardiovascular health and deaths in patients taking different angiotensin-receptor blockers are needed.

This study was published in July in CMAJ (Canadian Medical Association Journal).

Dr. Antoniou has received unrestricted research grants from Merck and Pfizer.

Reviewed by: 
Review Date: 
July 10, 2013
Last Updated:
July 30, 2013