Angiotensin receptor blockers (ARBs) play an important role in regulation of blood
pressure.Telmisartan(Tel.) and Irbesartan(Irb.) are structurally quite different than older
ARBs (Valsartan,Losartan) and could function as selective peroxisome prolifarator
activated receptor gamma( PPAR gamma) agonist to increase insulin sensitivity .They could
be very useful in treatment of coexisting type II diabetes and hypertensive.
In animal model of insulin resistance (10% fructose for 5 weeks), treatment with
either Tel. (5 mg/Kg/day)or Irb. (50 mg/Kg/day)during last 2 weeks of induction of
insulin resistance improved serum levels of glucose, Triglycerides(TG) total
cholesterol (TC),high density lipoprotein (HDLc),low density lipoprotein (LDLc) and
hypertension. Tel. but not Irb .has significant effect on increased body weight.
The improvement of insulin sensitivity by Tel. and Irb. may be through multiple
mechanisms : including strong binding affinity and slow dissociation to angiotensin
receptor( AR), acting as partial agonist on PPAR gamma receptor which may affect
glucose and lipid metabolism, attenuate serum adiponectin which was recognized as
marker of PPAR activation .The later may have potential effect on adipocyte
differentiation, increase NO generation which result in increase in skeletal blood
flow, decrease in sympathetic activity, enhancing insulin signaling and increase
sensitivity of peripheral cell to insulin. |
