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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.comCevdet 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