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A comparative study on the effectiveness of losartan/hydrochlorothiazide and telmisartan/hydrochlorothiazide in

Toshihiro Hamada1, Masanari Kuwabara, Arisa Watanabe

  • 1Department of Regional Medicine, Tottori University Faculty of Medicine , Yonago , Japan .

Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|July 20, 2013
PubMed

Insights

Losartan/HCTZ combination therapy did not affect uric acid or glucose metabolism in hypertensive patients. However, telmisartan/HCTZ therapy impaired uric acid metabolism and worsened glucose metabolism.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Hypertension management often involves combination therapies.
  • The metabolic effects of different antihypertensive drug combinations require thorough investigation.
  • Understanding the impact on uric acid and glucose metabolism is crucial for patient outcomes.

Purpose of the Study:

  • To compare the long-term effects of low-dose hydrochlorothiazide (HCTZ) with losartan (LOS) versus telmisartan (TEL) on uric acid (UA) and glucose metabolism in hypertensive patients.
  • To evaluate the impact of LOS+HCTZ and TEL+HCTZ on serum UA levels, UA clearance, and glucose homeostasis markers.

Main Methods:

  • A study involving 59 hypertensive patients allocated to either LOS (50 mg/day) + HCTZ (12.5 mg/day) or TEL (40 mg/day) + HCTZ (12.5 mg/day) for one year.
  • Assessment of blood pressure and biochemical parameters (blood and urine) before and after treatment.
  • Analysis included serum UA, creatinine clearance, fasting plasma glucose, HbA1c, and HOMA-R.

Main Results:

  • Both LOS+HCTZ and TEL+HCTZ effectively reduced blood pressure without significant differences.
  • LOS+HCTZ did not alter serum UA levels or UA clearance/creatinine clearance (CUA/Ccr), while TEL+HCTZ significantly increased serum UA and reduced CUA/Ccr.
  • Neither combination affected fasting glucose, HbA1c, or HOMA-R, except TEL+HCTZ increased HOMA-R in patients with elevated baseline UA.

Conclusions:

  • LOS+HCTZ demonstrated a neutral effect on uric acid and glucose metabolism, potentially due to losartan's action on URAT1.
  • TEL+HCTZ was associated with impaired uric acid metabolism and worsened glucose metabolism, particularly in patients with higher baseline UA levels.
  • These findings suggest differential metabolic impacts of losartan versus telmisartan when combined with HCTZ in hypertensive patients.
Abstract

Keywords:
HOMA-Rhydrochlorothiazidelosartanserum uric acidtelmisartan

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