Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017

AFRICA

191

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,

ahin Bozok

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 characteris-

tics, 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, and operative and postoperative

features. Microalbuminuria levels between the groups differed

significantly in the pre-operative period, first hour postopera-

tively 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

Submitted 12/10/15, accepted 16/10/16

Published online 10/11/16

Cardiovasc J Afr

2017;

: 191–195

www.cvja.co.za

DOI: 10.5830/CVJA-2016-089

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 andhyperfiltration, a prothrombotic state,

and a low-grade chronic inflammatory state.

Microalbuminuria

is also associated with several cardiovascular disease risk

factors, such as hyperglycaemia, hypertension, dyslipidaemia,

renal dysfunction, obesity and smoking.

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.

Reduction of

microalbuminuria in diabetics may retard its progression to overt

diabetic nephropathy.

Once microalbuminuria is present, the rate of progression to

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

angiotensin system.

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.

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.

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

Department of Cardiovascular Surgery, Faculty of

Medicine, Hacettepe University, Ankara, Turkey

Cevdet Furat, MD

Riza Dogan, MD

Department of Cardiovascular Surgery, Faculty of

Medicine, Recep Tayyip Erdogan University, Rize, Turkey

Gokhan Ilhan, MD

Department of Cardiovascular Surgery, Zonguldak Atatürk

State Hospital, Zonguldak, Turkey

Ekrem Bayar, MD

Department of Cardiovascular Surgery, Faculty of

Medicine, Katip Çelebi University,

zmir Atatürk Training and Research Hospital,

zmir, Turkey

Berkan Ozpak, MD

Department of Cardiovascular Surgery, Ada Hospital,

Giresun, Turkey

Hakan Kara, MD

Department of Cardiovascular Surgery, Faculty of

Medicine, Bahcesehir University, Istanbul, Turkey

ahin Bozok, MD,

sahinboz@yahoo.com