Effectiveness of using long-acting angiotensin II type 1 receptor blocker in Japanese obese patients with metabolic syndrome on morning hypertension monitoring by using telemedicine system (FUJIYAMA Study)

Abstract

Aim: Recently, obesity patients have been diagnosed as metabolic syndrome. The aim of this study was to evaluate which angiotensin type 1 receptor blockers (ARBs), telmisartan or candesartan, is superior for the control of home blood pressure (BP) in the morning when the outpatient clinic BP was well controlled in the patients with metabolic syndrome.

Methods: The patients with metabolic syndrome were enrolled. Home BP was monitored by using a telemedicine system. After a 2- to 4-week control period to establish baseline home BP values, these patients were randomly divided into telmisartan (20–80 mg) and candesartan (4–12 mg) groups. These end points were evaluated by using the telemedicine system during steady-state active therapy. A total of 356 patients attending 60 outpatient Japanese centers were recruited.

Results: On a day of active therapy, telmisartan significantly lowered both systolic and diastolic home BP in the morning to a greater extent compared to candesartan. At the end of the study, reductions in systolic and diastolic home BP in the morning, in telmisartan group were significantly larger compared to the changes in the candesartan group (systolic; Tel: 12.0 ± 8.9 versus Can: 8.1 ± 17.1 mmHg, p = 0.0292, diastolic; Tel: 7.4 ± 6.1 versus Can: 3.7 ± 6.8 mmHg, p = 0.0053). Additionally in the telmisartan treated group, LDL-cholesterol showed significant reduction (p = 0.037), but candesartan did not.

Conclusion: The present study by using the telemedicine system clearly demonstrated that telmisartan has a strong effect on reducing morning home BP, and a good effect on lipid metabolism in patients with metabolic syndrome.

• Home blood pressure
• hypertension
• metabolic syndrome
• office blood pressure
• telemedicine

Acknowledgements

The authors express their sincere thanks to Dr. Akihiko Nitta (Nitta Clinic), Dr. Chiduru Shuto (Oobukuro Clinic), Dr. Eiichi Nishida (Noda Clinic), Dr. Hajime Yoza (Heart Life Hospital), Dr. Hiroshi Shuto (Sengendai Station Building Clinic), Dr. Hisao Oyama (Oyama Clinic), Dr. Hisashi Noguchi (Minamikoshigaya Kenshinkai Clinic), Dr. Junichi Shibuya (Shibuya Clinic), Dr. Katsuhiko Yamada (Kousei Medical Clinic), Dr. Kenshi Moriwaki (Moriwaki Clinic), Dr. Kensuke Matsushima (Matsushima Clinic), Dr. Koji Kusakabe (Makita General Hospital), Dr. Masahiko Tanaka (Kanetsu Hospital), Dr. Masashi Ichikawa (Fuchu Yotsuya Clinic), Dr. Masato Takagi (Shisei Hospital), Dr. Masayoshi Nagata (Iruma Heart Hospital), Dr. Masayoshi Sone (Sone Clinic), Dr. Mitsuji Tsurui (Tsurui Clinic), Dr. Mitsuo Obana (Obana Medical Clinic), Dr. Munekazu Ryuzaki (Kawasaki Munincipal Ida Hospital), Dr. Nobutaka Takaetsu (Shonan Hospital), Dr. Noriko Yamamoto (Yamamoto Clinic), Dr. Noriyuki Amano (Amano Clinic), Dr. Noriyuki Iwase (Iwase Medical Clinic), Dr. Rie Hoshino (Ohtani Orthopedic Hospital), Dr. Shigeo Yatagai (Yatagai Clinic), Dr. Shin Totokawa (Gyotoku Flower Street Clinic), Dr. Shuichi Sajima (Ginobay Memorial Hospital), Dr. Hiromichi Nakachi (Ginowan Kinen Hospital), Dr. Takashi Kondo (Kondo Clinic), Dr. Takashi Ohe (Ohe Clinic), Dr. Terumasa Tsuchiya (Hikari Clinic), Dr. Yasuhiko Nakada (Aisei Clinic), Dr. Yasukatsu Nakano (Nakano Internal Medicine Clinic) and Dr. Yasushi Iwaida (Kokan Clinic), for the enrollment of the patients in this study.