Effects of Telmisartan and Ramipril on Adiponectin and Blood Pressure in Patients with Type 2 Diabetes

BACKGROUND Adiponectin is secreted by adipose tissue and may play a role in cardiovascular disease. We examined adiponectin levels in patients with type 2 diabetes who participated in the Telmisartan vs. Ramipril in Renal Endothelial Dysfunction (TRENDY) study. METHODS A total of 87 patients were assessed at baseline and following 9 weeks treatment with the angiotensin-receptor blocker telmisartan (final dose, 80 mg; n = 45) or the angiotensin-converting enzyme inhibitor ramipril (final dose, 10 mg; n = 42). Adiponectin levels were measured in plasma by radioimmunoassay. RESULTS Adiponectin levels were inversely correlated with systolic (SBP; r = -0.240, P < 0.05) and diastolic (DBP; r = -0.227, P < 0.05) blood pressure at baseline and following treatment with telmisartan or ramipril (SBP: r = -0.228, P < 0.05; DBP: r = -0.286, P < 0.05). Changes in adiponectin levels were related to changes in SBP (r = -0.357, P < 0.01) and DBP (r = -0.286, P < 0.01). There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) mu g/ml, P < 0.01) but not in the ramipril group (0.17 (95% CI, -0.56 to 0.90) (mu g/ml, P = 0.67). Blood pressure reduction in the telmisartan group (Delta SBP: -13.5 (95% CI, -17.0 to -10.0) mm Hg; Delta DBP: -7.6 (95% CI, -9.8 to -5.3) mm Hg, each P < 0.001) was significantly (P <= 0.01 for SBP and P < 0.01 for DBP) greater than in the ramipril group (Delta SBP:-6.1 (95% CI,-6.2 to -2.0) mm Hg; Delta DBP: -2.7 (95% CI,-5.0 to -0.5) mm Hg; P < 0.01 and P < 0.05, respectively). CONCLUSION Adiponectin is correlated with blood pressure in patients with type 2 diabetes. Whether increased adiponectin contributes to the blood pressure-lowering effect of telmisartan needs further study.