Comparison of the effectiveness of amlodipine and telmisartan in macrovascular and microvascular complications in type2 diabetes mellitus patients with hypertension

Back ground and Objectives: Antihypertensive drugs Amlodipine and Telmisartan are used to control blood pressure and reduce macro and microvascular complications in diabetic patients with hypertension. Telmisartan is an angiotensin II receptor antagonist used in the management of hypertension. Telmisartan is a partial agonist of peroxisome proliferator –activated receptor. So this lower the risk of acute myocardial infarction, stroke, or heart failure in diabetic patients. Amlodipine is a calcium channel blocker. It works to control blood pressure and reduce the number of angina attacks by widening and relaxing blood vessels. The main objective of the study is to evaluate effectiveness of amlodipine and telmisartan in macrovascular (cardiovascular) and microvascular (nephropathic) complications in type 2 diabetes mellitus patients with hypertension. Methods: A prospective, cross sectional study conducted in type 2 diabetes patients with hypertension at general medicine inpatients and outpatients department in a 500 bed tertiary care teaching hospital. After obtaining the consent Patients were categorised into 2 groups, one group treated with Amlodipine (5mg\day) and other group treated with Telmisartan 40(mg\day). Patients are evaluated for the parameter like blood pressure and echocardiograph to detect cardiovascular complication microalbumin and serum creatinine to detect nephropathic complications at baseline and follow up after 6 week. Results and Discussion: A total of 60 patients were evaluated (30 patients in each group), with a predominance of male (51%) in both groups. After 6 weeks of treatment, the Amlodipine and Telmisartan group no significant difference in SBP (131mmHg and 127mmHgrespectively.P=0.206), and DBP (86.67mmHg and 82.67mmHg respectively, p=0.076), although the values were slightly lower in Telmisartan group. In the case of serum creatinine, in amlodipine group it about 1.28 and 1.23 in Telmisartan group. Serum creatinine value lower in Telmisartan group, but there is no significant difference (p value about 0.656). After 6 weeks of treatment with Amlodipine microalbumine present in 20% of patients and it present but decreased in 26.7% and it not present in 53.3%patients.in Telmisartan group it not present in 63.3%patients,present but it decreased in 16.7% and present in 20% patients. Telmisartan group has higher reduction in microalbumine compared to that of Amlodipine group. When comparing ECHO of the two groups after 6 weeks of treatment, in Amlodipine group 70% of the patients have complication present but decreased. Complication not present in 30% of patients.in the case Telmisartan group complication not present in 56.7% patients and complication present but decreased in 43.3% patients. Conclusion: The result of the study shows that after 6 weeks of treatment, there is no significant difference between laboratorical parameters in two groups. The result shows the effectiveness of Amlodipine and telmisartan in macrovascular (cardiovascular complication detected from ECHO) and microvascular complication (nephropathy detected by checking microalbuminuria and serum creatinine) are almost same. Telmisartan shows higher reduction in parameters like SBP, DBP, SC and microalbumine compared to Amlodipine group. Amlodipine show higher reduction in uric acid and fasting blood sugar compared to Telmisartan group.