Effects of candesartan in hypertensive patients with type 2 diabetes mellitus on inflammatory parameters and their relationship to pulse pressure

We administered candesartan therapy (12？mg daily) for 6？months and evaluated whether there was improvement in serum inflammatory parameters high molecular weight adiponectin (HMW-ADN), plasminogen activator inhibitor-1 (PAI-1), highly sensitive C-reactive protein (Hs-CRP), vascular cell adhesion molecule-1 (VCAM-1) in serum and urinary-8-hydroxydeoxyguanosine (U-8-OHdG). We then analyzed the relationship between the degree of lowering of blood pressure and inflammatory factors and the relationship between pulse pressure and inflammatory factors. Finally, we analyzed predictive factors in patients who received the protective benefit of candesartan.After 6？months of treatment, significant improvements from baseline values were observed in all patients in HMW-ADN and PAI-1 but not in Hs-CRP, VCAM-1 and U-8-OHdG. Multilinear regression analysis was performed to determine which factors could best predict changes in HMW-ADN and PAI-1. Changes in blood pressure were not significant predictors of changes in metabolic factors in all patients. We found that the group with baseline pulse pressure <60？mmHg had improved HMW-ADN and PAI-1 values compared with the group with baseline pulse pressure ≥ 60？mmHg. These results suggest that pulse pressure at baseline could be predictive of changes in HMW-ADN and PAI-1.Candesartan improved inflammatory parameters (HMW-ADN and PAI-1) in hypertensive patients with type 2 diabetes mellitus of long duration independent of blood pressure changes. Patients with pulse pressure <60？mmHg might receive protective benefits by candesartan.UMIN000007921Almost half of type 2 diabetic patients are reported to have hypertension during their lifetime [1], and the coexistence of hypertension and diabetes mellitus especially increases the risk of cardiovascular events. Moreover, much of this excess risk is attributable to coexistent hypertension [2]. Treatment of hypertension in patients with type 2 diabetes mellitus of short duration has been shown to re