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SA JOURNAL OF DIABETES & VASCULAR DISEASE

RESEARCH ARTICLE

VOLUME 14 NUMBER 2 • DECEMBER 2017

57

Telmisartan decreases microalbuminuria in patients

with type 2 diabetes mellitus following coronary artery

bypass grafting

Cevdet Furat, Riza Dogan, Gokhan Ilhan, Ekrem Bayar, Berkan Ozpak, Hakan Kara,

Sahin Bozok

Correspondence to: Sahin Bozok

Department of Cardiovascular Surgery, Faculty of Medicine, Bahcesehir

University, Istanbul, Turkey

e-mail:

sahinboz@yahoo.com

Cevdet Furat, Riza Dogan

Department of Cardiovascular Surgery, Faculty of Medicine, Hacettepe

University, Ankara, Turkey

Gokhan Ilhan

Department of Cardiovascular Surgery, Faculty of Medicine, Recep Tayyip

Erdogan University, Rize, Turkey

Ekrem Bayar

Department of Cardiovascular Surgery, Zonguldak Atatürk State Hospital,

Zonguldak, Turkey

Berkan Ozpak

Department of Cardiovascular Surgery, Faculty of Medicine, Katip Çelebi

University, Ízmir Atatürk Training and Research Hospital, Ízmir, Turkey

Hakan Kara

Department of Cardiovascular Surgery, Ada Hospital, Giresun, Turkey

Previously published in

Cardiovasc J Afr

2017;

28

: 191–195

S Afr J Diabetes Vasc Dis

2017;

14

: 57–60

Abstract

Objective:

This prospective study aimed to investigate the

effects of the selective angiotensin receptor antagonist,

telmisartan, on microalbuminuria after coronary artery

bypass surgery in patients with diabetes mellitus.

Methods:

Patients were divided into two groups with block

randomisation, using the sealed envelope technique: group

T (telmisartan group) consisted of patients who received the

angiotensin receptor blocking agent telmisartan 80 mg daily

for at least six months in the pre-operative period; group

N-T (non-telmisartan group) consisted of patients who

received no telmisartan treatment. Clinical and demographic

characteristics, operative and postoperative features,

microalbuminuria and high-sensitivity C-reactive protein

levels were compared.

Results:

Forty patients met the eligibility criteria for the

study. The groups did not differ with regard to clinical and

demographic characteristics, andoperativeandpostoperative

features. Microalbuminuria levels between the groups

differed significantly in the pre-operative period, first hour

postoperatively and fifth day postoperatively. C-reactive

protein levels between the groups differed significantly on

the fifth day postoperatively.

Conclusion:

Telmisartan was useful for decreasing systemic

inflammation and levels of urinary albumin excretion in

patients who had type 2 diabetes mellitus and had undergone

coronary artery bypass surgery.

Keywords:

telmisartan, coronary artery bypass grafting, diabetes

mellitus, microalbuminuria

Microalbuminuria is considered to be a marker of endothelial

dysfunction and is a predictor of cardiovascular disease and

mortality.

1,2

Studies have implicated systemic vascular damage,

extensive endothelial dysfunction, a glomerular haemodynamic

state of hyperperfusion and hyperfiltration, a prothrombotic state,

and a low-grade chronic inflammatory state.

3

Microalbuminuria is

also associated with several cardiovascular disease risk factors, such

as hyperglycaemia, hypertension, dyslipidaemia, renal dysfunction,

obesity and smoking.

4

All of these factors contribute to the genesis

of atherosclerosis.

Proteinuria is also an early marker for potentially serious renal

disease in diabetics. It refers to an abnormally increased excretion

rate of albumin in the urine, and is a sensitive indicator of generalised

microvascular disease and a marker for vascular endothelial injury

and multi-organ damage.

5

Reduction of microalbuminuria in

diabetics may retard its progression to overt diabetic nephropathy.

5

Once microalbuminuria is present, the rate of progression

to end-stage renal disease can be delayed by inhibition of the

renin–angiotensin system.

6

There is evidence that the use of agents

that block the renin–angiotensin–aldosterone system, notably

angiotensin receptor antagonists, may provide cardiovascular

protection to diabetic patients with microalbuminuria.

Microalbuminuria increases following open-heart surgery where

coronary artery bypass grafting (CABG) is utilised.

7

CABG activates

an inflammatory cascade, which may increase capillary permeability

and cause microalbuminuria. The increase in capillary permeability

may induce exudation of proteins from the lung capillaries into

the capillary–alveolar interspace and alveoli, causing the so-called

postperfusion lung, which resembles pulmonary oedema. In a

recent study, Loef

et al.

demonstrated that CABG potentiates

transient renal failure and microalbuminuria.

8

In this study, we aimed to investigate the effects of the selective

angiotensin II receptor antagonist, telmisartan, on microalbuminuria

after CABG surgery in patients with diabetes mellitus.

Methods

This observational study was approved by the local institutional

review board (LUT/05/38/2006) and conducted in accordance with

the amended Declaration of Helsinki and Good Clinical Practice