Recent Longevity News for the seven days ending 8/26/09.  You should consult your doctor if you are taking any medications.

HPV Vaccine Likely to Prevent Many Cases of Penile Carcinoma - Medscape, 8/25/09 - "Nearly half of cancers of the penis are associated with infection by high-risk human papillomavirus (HPV-16 and HPV-18) ... Dr. de Sanjose and associates point out that HPV prophylactic vaccine in men appears to be safe and immunogenic"

Higher Diastolic, Not Systolic, Blood Pressure Linked to Impaired Cognition - Medscape, 8/25/09 - "Higher diastolic blood pressure (DBP) levels, but not systolic blood pressure (SBP) levels, can impair cognitive status in individuals without prior history of stroke or transient ischemic attack"

More Obesity Blues: Obese People Are At Greater Risk For Developing Alzheimer's, Study Finds - Science Daily, 8/25/09 - "They found that obese people had 8 percent less brain tissue than people with normal weight, while overweight people had 4 percent less tissue. According to Thompson, who is also a member of UCLA's Laboratory of Neuro Imaging, this is the first time anyone has established a link between being overweight and having what he describes as "severe brain degeneration.""

Link Between Erectile Dysfunction And Obesity Explored In Obesity And Weight Management - Science Daily, 8/25/09 - "Obese men are at increased risk for erectile dysfunction (ED), likely caused by atherosclerosis-related hypertension and cardiovascular disease, as well as hormonal changes associated with obesity"

Fat In The Liver -- Not The Belly -- May Be A Better Marker For Disease Risk - Science Daily, 8/25/09 - "Having too much liver fat is known as nonalcoholic fatty liver disease ... when fat collects in the liver, people experience serious metabolic problems such as insulin resistance, which affects the body's ability to metabolize sugar. They also have increases in production of fat particles in the liver that are secreted into the bloodstream and increase the level of triglycerides"

Low-carb Diets Linked To Atherosclerosis And Impaired Blood Vessel Growth - Science Daily, 8/25/09 - "Even as low-carbohydrate/high-protein diets have proven successful at helping individuals rapidly lose weight, little is known about the diets' long-term effects on vascular health ... mice placed on a 12-week low carbohydrate/high-protein diet showed a significant increase in atherosclerosis, a buildup of plaque in the heart's arteries and a leading cause of heart attack and stroke ... our research suggests that, at least in animals, these diets could be having adverse cardiovascular effects that are not reflected in simple serum markers"

Tea consumers may have younger biological age - Nutra USA, 8/25/09 - "The study’s findings are based on the telomere lengths of 976 Chinese men and 1,030 Chinese women aged over 65. The participants’ dietary habits were evaluated using a food frequency questionnaire ... Overall, only tea consumption was associated with telomere length. The highest intakes, three cups or 750 millilitres per day, was associated with significantly longer telomere lengths, compared to people who drank 70 millilitres per day or less, said the researchers" - [Abstract] - See green tea extract at Amazon.com.

Should Young Men Be Vaccinated With Gardasil®? - Medscape, 8/24/09 - "Gardasil® safety and immunogenicity trials included 9- to 15-year-old boys and demonstrated a robust immunologic response in this population. If efficacy in males is demonstrated in clinical trials, it is likely that vaccination may be recommended for prevention of anogenital warts (and, indirectly, infection and anogenital neoplasia and warts in partners); a subset of anal, penile, oral, and head and neck cancers; and juvenile respiratory papillomatosis in their children" - More reasons to get that vaccine:

• Sharp Increase In HPV-positive Tonsil Cancer Found - Science Daily, 4/2/09 - "Because the tumours produce so few symptoms, patients seek medical care when the disease is relatively advanced, often after the tumours have spread to the lymph glands of the throat, possibly making the prognosis much worse ... More recent studies, however, have demonstrated a link between HPV and tonsil cancer, so that today an HPV infection is also one of the established risk factors ... Since 1970, the cumulative incidence of HPV-positive tonsil cancer has increased from 23 to 93 per cent"
• ABC News: The Oral Sex Cancer Connection -  ABC News, 10/15/08 - "These are patients that are young. They are in their 30s and 40s. They are nonsmokers, and they don't drink alcohol ex ... There is absolutely a link between oral sex and oral cancer" - Click here for the 7 minute video.  I says that boys may want to get the HPV vaccine.
• HPV-related oral cancers rise among younger men - baltimoresun.com, 4/14/08 - "They're men in their 40s, and even 30s, whose cancer is brought on by the increasingly common human papillomavirus (HPV) ... researchers now believe that the increase in certain oral cancers can be traced to the spread of the virus through oral sex ... New studies suggest that HPV-related oral cancer cases are on pace to eventually surpass cases of cervical cancer in the United States ... many doctors do not realize that they should be on the lookout for oral cancer in younger patients ... The public is unaware of this"
• Oral sex-related cancer at 30-year high - New Scientist, 2/28/08 - "The incidence of oral cancer due to a virus transmitted during oral sex has increased steeply over the last 30 years ... The rise was largest among young white males, suggesting this group is more likely to have oral sex at a younger age now than it was 20 years ago ... What is not in doubt, says Gillison, is the need to consider giving boys the HPV vaccine, to protect them from the disease ... These strains are also thought to cause oral cancer, as well as penile and anal cancer"
• HPV-Related Oral Cancers on the Rise in Men - oncologystat.com, 2/2/08 - "The virus usually associated with cervical cancer has been linked to oral cancer in men, and is responsible for as many cases of the disease as tobacco and alcohol"
• Human Papillomavirus in Cervical and Head-and-Neck Cancer - Medscape, 12/17/07 - "mounting epidemiological, molecular and clinical evidence indicates that high-risk HPVs (especially HPV.16) account for the development of headand-neck carcinoma in some individuals who do not have the classical risk factors for this disease (i.e. a history of tobacco use and/or alcohol consumption)"
• Loud and clear on oral cancer - USATODAY.com, 11/25/07 - "The most likely culprit, he says: the same strains of human papillomavirus (HPV) that cause most cases of cervical cancer. A likely mode of transmission is oral sex"
• Human Papilloma Virus Vaccines May Decrease Chances Of Oral Cancer - Science Daily, 8/30/07 - "oral and oropharyngeal squamous cell carcinoma (OOSCC) have been linked to high-risk HPV strains, the same strains that cause cervical cancer ... It's possible that oral and oropharyngeal cancers could be reduced if vaccination were more widespread; however, additional research is needed"
• Oral Sex Implicated in Some Throat and Neck Cancers - washingtonpost.com, 8/27/07 - "Human papillomavirus (HPV), which is believed to be responsible for most cervical cancers, may also be at the root of many cancers of the mouth and throat ... Previous research has found that up to 50 percent of nonsmokers with throat and mouth cancers were infected with HPV"

Also related to above that was also in the 8/24/09 news:

HPV Infections Linked to Penile Cancer - WebMD, 8/24/09 - "HPV-16 is the leading HPV type liked to penile cancer; HPV-18 is the second most common type ... The study's authors say about 7,000 cases of penile cancer could be prevented each year if such infections could be wiped out. A vaccine called Gardasil is available in the U.S. to protect girls and women against certain HPV infections. It is not approved for men"

High Serum Insulin Levels And Risk Of Prostate Cancer - Science Daily, 8/23/09 - "when subjects in the second through fourth quartiles of serum insulin concentration were compared with those in the first or lowest quartile, higher insulin levels within the normal range were associated with statistically significantly increased risk of prostate cancer. Risk was not associated with serum glucose concentration"

Why Low Vitamin D Raises Heart Disease Risks In Diabetics - Science Daily, 8/21/09 - "Low levels of vitamin D are known to nearly double the risk of cardiovascular disease in patients with diabetes ... When people are deficient in vitamin D, the macrophage cells eat more cholesterol, and they can't get rid of it. The macrophages get clogged with cholesterol and become what scientists call foam cells, which are one of the earliest markers of atherosclerosis" - See vitamin D at Amazon.com.

Rosiglitazone Increases Risk of Heart Failure, Death Compared With Pioglitazone - Doctor's Guide, 8/20/09 - "The researchers estimated that, for every 93 patients treated with rosiglitazone rather than pioglitazone, 1 additional cardiovascular event or death would be predicted to occur annually"

Increase In Visceral Fat During Menopause Linked With Testosterone - Science Daily, 8/20/09 - "The culprit is likely not age, as is commonly believed, but the change in hormone balance that occurs during the menopause transition ... Of all the factors we analyzed that could possibly account for the increase in visceral fat during this period in a woman's lifetime, levels of active testosterone proved to be the one most closely linked with abdominal fat ... in women, it is the change in the hormonal balance – specifically, the increase in active testosterone – that is predominantly responsible for visceral fat, and for the increased risk of cardiovascular disease"

Progesterone Leads To Inflammation, Scientists Find - Science Daily, 8/19/09 - "Exposure to progesterone in normal amounts and in normal circumstances causes inflammation, which promotes breast development ... exposure to progesterone in menopausal hormone therapy is known to increase breast cancer risk"

Homes Pollute: Linked To 50 Percent More Water Pollution Than Previously Believed - Science Daily, 8/19/09 - "scientists are reporting some unsettling news about homes in the residential areas of California. The typical house there — and probably elsewhere in the country — is an alarming and probably underestimated source of water pollution ... current models may underestimate the amount of pollution contributed by homes by up to 50 percent ... Pollutants detected in outdoor runoff included ant-control pesticide products"

Whole Grain Cereals, Popcorn Rich In Antioxidants, Not Just Fiber, New Research Concludes - Science Daily, 8/19/09 - "We found that, in fact, whole grain products have comparable antioxidants per gram to fruits and vegetables. This is the first study to examine total phenol antioxidants in breakfast cereals and snacks, whereas previous studies have measured free antioxidants in the products ... Polyphenols are a group of chemicals found in many fruits, vegetables, and other plants, such as berries, walnuts, olives, tea leaves and grapes. Known as antioxidants, they remove free radicals from the body. Free radicals are chemicals that have the potential to cause damage to cells and tissues in the body"

Scientists Help Explain Effects Of Ancient Chinese Herbal Formulas On Heart Health - Science Daily, 8/19/09 - "Nitric oxide is crucial to the cardiovascular system because it signals the inner walls of blood vessels to relax, which facilitates the flow of blood through the heart and circulatory system. The messenger molecule also eliminates dangerous clots, lowers high blood pressure and reduces artery-clogging plaque formation ... In the study, researchers performed laboratory tests on DanShen, GuaLou and other herbs purchased at a Houston store to assess their ability to produce nitric oxide"

Abstracts from this week's Doctor's Guide Nutrition/Dietetics plus abstracts from my RSS feeds (Click here for the journals, the PubMed ones at the top):

Consumption of filtered and boiled coffee and the risk of first acute myocardial infarction; a nested case/referent study - Nutr Metab Cardiovasc Dis. 2009 Aug 18 - "Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis"

Improving cardiovascular risk--applying evidence-based medicine to glucose-lowering therapy with thiazolidinediones in patients with type 2 diabetes - Int J Clin Pract. 2009 Sep;63(9):1354-68 - "Pioglitazone is the preferred thiazolidinedione to reduce cardiovascular risk in people with type 2 diabetes"

Liver Carbohydrate and Lipid Metabolism of Insulin-Deficient Mice Is Altered by trans-10, cis-12 Conjugated Linoleic Acid - J Nutr. 2009 Aug 19 - "Feeding mice the trans-10, cis-12 (t10c12) conjugated linoleic acid (CLA) isomer is associated with lipodystrophy, insulin resistance, hyperinsulinemia, and liver steatosis. It has been hypothesized that CLA-induced liver steatosis is the result of increased hepatic lipogenesis stimulated by high insulin levels. We studied the effects of a 12-d t10c12CLA treatment (1 g/100 g diet) on liver carbohydrate and lipid metabolism in control and streptozotocin (STZ)-injected mice. STZ mice were characterized by insulin deficiency, hypertriglyceridemia, and depletion of liver triglyceride and glycogen. Remarkably, feeding t10c12CLA to diabetic mice (STZ-CLA) normalized these variables. Reconstitution of fat stores in the livers of STZ-CLA mice was associated with lower fatty acid (FA) oxidation rates and greater malonyl-CoA concentration than in STZ mice. FA translocase and VLDL receptor mRNA levels were greater in STZ-CLA than in STZ mice, suggesting that t10c12CLA increased liver lipid uptake. Phosphoenolpyruvate carboxykinase mRNA levels and AMP kinase phosphorylation were lower in STZ-CLA than in STZ mice, indicating that t10c12CLA may reduce glucogenic activity and promote glycogenesis in diabetic mice. Because glycemia and glucokinase expression were not modified by t10c12CLA treatment, we postulated that glycogen accumulation is likely not the result of an effect of t10c12CLA on plasma glucose utilization, but rather is due to the contribution of lactate, the concentration of which was higher in muscle of STZ-CLA mice. The results demonstrate that t10c12CLA stimulates liver lipid accumulation in the absence of insulin and, thus, suggest that t10c12CLA can improve liver carbohydrate and lipid metabolism in type I diabetic mice" - See conjugated linoleic acid at Amazon.com.

Neat Tech Stuff :

Health Focus (First line medications for hypertension):

I feel that Micardis (telmisartan) (ARBs) with Altace (ramipril) (an ACE inhibitor, if two drugs are required), are the way to go for the least side effects.  I'm not a doctor, just someone that's done a lot of reading and experimenting with different blood pressure medications.  Consult your doctor before taking any supplement or medication.  See:

• Patient Compliance with Antihypertensive Therapy Appears Longer for Those Taking Angiotensin II Antagonists - Doctor's Guide, 7/18/02 - "The researchers found that the class of drug had a statistically significant effect on the patients' persistence of compliance. Angiotensin II antagonists had the highest rate of persistence followed by ACE inhibitors, calcium channel blockers, beta-blockers, and diuretics"
• Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials - J Hum Hypertens. 2008 Nov 6 - "Telmisartan had fewer drug-related adverse events than enalapril (RR 0.57, 95% CI 0.44-0.74), ramipril (RR 0.44, 95% CI 0.26-0.75), lisinopril (RR 0.70, 95% CI 0.56-0.89) and perindopril (RR 0.52, 95% CI 0.28-0.98). The meta-analysis indicates that telmisartan provides a superior BP control to ACEIs (enalapril, ramipril and perindopril) and has fewer drug-related adverse events and better tolerability in hypertensive patients"
• Effects of angiotensin II receptor blockers on diabetic nephropathy - J Hypertens. 2009 Jul;27 Suppl 5:S15-21 - "Key beneficial effects of ARBs and ACE inhibitors throughout the kidney disease continuum are primarily explained by blood pressure lowering effects and partially by their direct blockade of angiotensin II. Recent studies have shown that telmisartan, an ARB with high lipophilicity and the longest half-life compared with other ARBs, provides benefits on markers of cardiovascular risk, that is, microalbuminuria and slowing of early-stage nephropathy"
• Clinical evidence from ONTARGET: the value of an angiotensin II receptor blocker and an angiotensin-converting enzyme inhibitor - J Hypertens. 2009 Jul;27 Suppl 5:S23-9 - "Telmisartan was better tolerated than ramipril in this high-risk population: notably, the incidence of cough and angioedema was significantly lower with telmisartan alone. Thus, telmisartan provides comparable efficacy to ramipril with less adverse events, which may encourage patient compliance"
• Achieving blood pressure goals: should angiotensin II receptor blockers become first-line treatment in hypertension? - J Hypertens. 2009 Jul;27 Suppl 5:S9-14 - "Recently, the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study established that telmisartan reduces morbidity and mortality in a broad cross-section of patients at high risk for heart and vascular events, to an extent similar to that of the angiotensin-converting enzyme inhibitor ramipril. In addition, ONTARGET demonstrated that telmisartan is somewhat better tolerated than ramipril. Attributes such as effective blood pressure lowering, tolerability and convincing outcomes data mean that ARBs satisfy the requirements for first-line antihypertensive agents"
• Cognitive Deficit in Amyloid-{beta}-Injected Mice Was Improved by Pretreatment With a Low Dose of Telmisartan Partly Because of Peroxisome Proliferator-Activated Receptor-{gamma} Activation - Hypertension. 2009 Jul 27 - "Taken together, our findings suggest that even a low dose of telmisartan had a preventive effect on cognitive decline in an Alzheimer disease mouse model, partly because of PPAR-gamma activation"
• New Blood Pressure Medication Has Fewer Side Effects, Global Study Suggests - Science Daily, 3/31/08 - "The study found a new drug telmisartan is as effective as the popular drug ramipril in reducing cardiovascular death in high risk patients and it has fewer side effects" - See telmisartan at OffshoreRx1.com.
• Telmisartan: The ACE of ARBs?  - Sharma 47 (5): 822 -- Hypertension, 3/27/06 - "telmisartan also reduced weight gain, increased total energy expenditure, and increased expression of key mitochondrial enzymes (cyclooxygenase-1 and mitochondrial transcription factor A) in skeletal muscle"
• Blood Pressure Linked to Erectile Dysfunction - WebMD, 5/16/05 - "Men on older high blood pressure medications (diuretics, beta-blockers) had higher rates and more severe erectile dysfunction than men on newer medications (calcium antagonists, ACE inhibitors, angiotensin II receptor blockers)"
• Evidence-Based Treatment of Hypertension: What's the Role of Angiotensin II Receptor Blockers? - Medscape, 4/8/05 - "The ARBs themselves are very well tolerated and are not associated with the side-effects known to cause compliance problems with beta blockers, ACE inhibitors and calcium channel blockers such as impotence, dry cough and peripheral oedema"
• Blood pressure drug reverses sexual dysfunction - Life Extension Magazine, 7/01 - "the active ingredient in Cozaar and Hyaar (losartan) can significantly improve sex lives of men who suffer from sexual dysfunction" - Does this pertain to other ARBs?  The following indicates that it might:
  • Valsartan Appears to Improve Sexual Function in Men and Women with Hypertension - Doctor's Guide, 5/18/03 - "Men and women being treated with the angiotensin II receptor blocker valsartan for mild-to-moderate hypertension appear to show improvements in sexual function and desire"
  • Impotent Patients on Valsartan Find Increased Interest in Sex; Use Sildenafil More Often: Presented at ASH - Doctor's Guide, 6/13/05 - "Hypertensive patients with erectile dysfunction who are taking the angiotensin II receptor blocker valsartan find they have increased sexual desire ... It could be related to the reactive stimulation of angiotensin cascade due to AT1 receptors blockade"
• Antihypertensive efficacy of telmisartan vs ramipril over the 24-h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomized trials - J Hum Hypertens. 2009 Feb 19 - "The adjusted mean treatment differences in the last 6-h mean ambulatory SBP/DBP were -5.8/-4.2 mm Hg after 8 weeks and -4.1/-3.0 mm Hg after 14 weeks, in favour of telmisartan (P<0.0001 for all four comparisons). Secondary end point results, including the mean 24-h ambulatory BP monitoring, day- and night-time BP and 24-h BP load, also significantly favoured telmisartan (P<0.0001). Both treatments were well tolerated; adverse events, including cough, were less common with telmisartan. These findings suggest that telmisartan is more effective than ramipril throughout the 24-h period and during the EMBPS; this may be attributable to telmisartan's long duration of effect, which is sustained throughout the 24-h dosing period"
• Telmisartan Increases the Permeability of Endothelial Cells through Zonula Occludens-1 - Biol Pharm Bull. 2009 Mar;32(3):416-20 - "telmisartan but not valsartan downregulated ZO-1 mRNA and protein levels, disrupted the distribution of ZO-1 in cultured endothelial cells, and increased the permeability of endothelial cells in a dose-dependent manner ... telmisartan disrupts the continuous pericellular distribution of ZO-1, downregulates the expression of ZO-1 in endothelial cells, and increases the permeability of endothelial cells at least partly through PI3K and the peroxisome proliferator-activated receptor gamma-dependent pathway"
• Effects of telmisartan on adiponectin levels and body weight in hypertensive patients with glucose intolerance - Metabolism. 2008 Oct;57(10):1473-8 - "Telmisartan decreased body weight while increasing serum adiponectin levels in hypertensive patients with glucose intolerance. Candesartan did not achieve similar improvements in these patients. Among ARBs, telmisartan may have a larger impact on obesity-related diseases that can lead to cardiovascular disorders"
• Telmisartan induces proliferation of human endothelial progenitor cells via PPARgamma-dependent PI3K/Akt pathway - Atherosclerosis. 2008 Dec 31 - "since endothelial progenitor cells (EPCs) are thought to play a critical role in ischemic diseases, we investigated effects of telmisartan on proliferation of EPCs ... These findings suggest that telmisartan might contribute to endothelial integrity and vasculogenesis in ischemic regions by increasing numbers of EPCs"
• Effects of Telmisartan and Ramipril on Adiponectin and Blood Pressure in Patients with Type 2 Diabetes - Am J Hypertens. 2008 Oct 30 - "There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) microg/ml, P < 0.01) but not in the ramipril group" - See my adiponectin page.  An increase in adiponectin is a good thing.
• Angiotensin II type 2 receptor blockade increases bone mass - J Biol Chem. 2008 Nov 11 - "Treatment with AT2 receptor blocker significantly enhanced the levels of bone mass and this effect was based on the enhancement of osteoblastic activity as well as the suppression of osteoclastic activity in vivo"
• Telmisartan improves insulin resistance in high renin nonmodulating salt-sensitive hypertensives - J Hypertens. 2008 Dec;26(12):2393-8 - "Nonmodulating (NMHT) is a high-renin subtype of salt sensitive hypertension, which additionally develops insulin resistance and oxidative stress. Conversely, modulating hypertensives (MHT) normally regulates renal hemodynamics after high sodium intake without metabolic impairment ... In NMHT, telmisartan, after 3 months treatment, significantly reduced fasting and 120 min insulinemia (fasting: 8.4 +/- 2, 120 min: 25 +/- 10 muU%; P < 0.01) compared either to basal values or ramipril treatment. Similarly, only in NMHT, compared with basal values and ramipril treatment, telmisartan improved the HOMA-IR index in both MHT (2.76 +/- 0.16 to 2.24 +/- 0.18, P < 0.05) and NMHT (from: 4.4 +/- 1 to 2.3 +/- 0.7) and triglyceride plasma levels (MHT: from 139 +/- 1.85 to 122 +/- 2.4 mg%, P < 0.05; NMHT: from: 223 +/- 12 to 146 +/- 10 mg%, P < 0.01). Finally, highly sensitive C-protein-reactive protein values were higher in NMHT (0.33 +/- 0.07 mg.dl) than in MHT (0.14 +/- 0.06 mg.dl; P < 0.01). Both treatments reduced highly sensitive C-protein-reactive protein in NMHT. (ramipril from 0.32 +/- 0.05 mg.dl to 0.26 +/- 0.06 m.dl (P < 0.05) and telmisartan from 0.34 +/- 0.05+/- to 0.20 +/- 0.05 mg.dl (P < 0.01). CONCLUSION: Our data suggest that the improvement of the insulin sensitivity by telmisartan, instead of a similar effect on blood pressure shown by both drugs, could be ascribed to the PPAR agonistic action of telmisartan. This opens an interesting therapeutic approach for patients with hypertension and altered glycemic metabolism"
• Medication To Lower Blood Pressure Reduces Outcome Of Cardiovascular Death, Heart Attack Or Stroke, Study Suggests - Science Daily, 8/31/08 - "Telmisartan reduced the outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure by a relative eight per cent ... However, when the outcome included cardiovascular death, heart attack or stroke (and not hospitalization for heart failure), telmisartan reduced that outcome by a significant 13 per cent"
• The angiotensin II receptor blocker telmisartan improves insulin resistance and has beneficial effects in hypertensive patients with type 2 diabetes and poor glycemic control - Diabetes Res Clin Pract. 2008 Aug 8 - "The telmisartan significantly improved HOMA-IR in hypertensive patients and also significantly decreased HbA1c in type 2 diabetic patients especially in the patients with poor glycemic control (HbA1c>==8.0%). These results indicate that telmisartan improves insulin resistance and gives beneficial effects in hypertensive patients with type 2 diabetes and a poor glycemic control"
• Comparison of the effects of telmisartan and olmesartan on home blood pressure, glucose, and lipid profiles in patients with hypertension, chronic heart failure, and metabolic syndrome - Hypertens Res. 2008 May;31(5):921-9 - "telmisartan had more beneficial effects on glucose and lipid profiles in patients with relatively high HbA1c, serum total and low-density lipoprotein cholesterol, and triglyceride levels. Therefore, we concluded that telmisartan was more beneficial than olmesartan for controlling blood pressure in the early morning, as well as for improving glucose and lipid profiles in patients with hypertension, chronic heart failure, and metabolic syndrome"
• Telmisartan prevents aneurysm progression in the rat by inhibiting proteolysis, apoptosis and inflammation - J Hypertens. 2008 Dec;26(12):2361-73 - "The angiotensin II type 1 receptor antagonist, telmisartan, prevents abdominal aortic aneurysm progression independently of blood pressure reduction by inhibiting proteolysis, apoptosis and inflammation in aortic tissue"
• Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy - Kidney Int. 2008 May 21 - "telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy, despite a similar reduction in blood pressure"
• The angiotensin II receptor blocker telmisartan improves insulin resistance and has beneficial effects in hypertensive patients with type 2 diabetes and poor glycemic control - Diabetes Res Clin Pract. 2008 Aug 8 - "The telmisartan significantly improved HOMA-IR in hypertensive patients and also significantly decreased HbA1c in type 2 diabetic patients especially in the patients with poor glycemic control (HbA1c>==8.0%). These results indicate that telmisartan improves insulin resistance and gives beneficial effects in hypertensive patients with type 2 diabetes and a poor glycemic control"
• Telmisartan prevented cognitive decline partly due to PPAR-gamma activation - Biochem Biophys Res Commun. 2008 Aug 17 - "Pretreatment with a non-hypotensive dose of telmisartan significantly inhibited such cognitive decline. Interestingly, co-treatment with GW9662, a PPAR-gamma antagonist, partially inhibited this improvement of cognitive decline. Another ARB, losartan, which has less PPAR-gamma agonistic effect, also inhibited Abeta-injection-induced cognitive decline; however the effect was smaller than that of telmisartan and was not affected by GW9662. Immunohistochemical staining for Abeta showed the reduced Abeta deposition in telmisartan-treated mice. However, this reduction was not observed in mice co-administered GW9662. These findings suggest that ARB has a preventive effect on cognitive impairment in Alzheimer disease, and telmisartan, with PPAR-gamma activation, could exert a stronger effect"
• Angiotensin Receptor Blockers Are Lower Incidence, Progression Of Alzheimer's Disease - Science Daily, 7/27/08 - "Researchers at Boston University School of Medicine (BUSM) have, for the first time, found that angiotensin receptor blockers (ARBs)—a particular class of anti-hypertensive medicines—are associated with a striking decrease in the occurrence and progression of dementia"
  Effects of telmisartan, a unique angiotensin receptor blocker with selective peroxisome proliferator-activated receptor-gamma-modulating activity, on nitric oxide bioavailability and atherosclerotic change - J Hypertens. 2008 May;26(5):964-972 - "In addition to a class effect of ARBs, telmisartan may have additional effects on nitric oxide bioavailability and atherosclerotic change through its PPARgamma-mediated effects in genetically hyperlipidemic rabbits"
• Microalbuminuria Reduction with Telmisartan in Normotensive and Hypertensive Japanese Patients with Type 2 Diabetes: A Post-Hoc Analysis of the Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) Study - Hypertens Res. 2008 Apr;31(4):657-64 - "The patients treated with either dose of telmisartan showed lower transition rates from microalbuminuria to overt nephropathy compared to the placebo group. In addition, more patients on telmisartan reverted to normoalbuminuria (UACR<30 mg/g creatinine): 15.5% of the 40 mg group, 19.6% of the 80 mg group, and 1.9% of the placebo group ... Side effects did not differ among the groups. The present study demonstrates that telmisartan prevents the progression of microalbuminuria (in some cases induces remission of albuminuria) in normotensive Japanese patients with type 2 diabetes. Telmisartan is shown to be safe and well tolerated in these patients"
• Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Improves Coronary Microcirculation and Insulin Resistance among Essential Hypertensive Patients without Left Ventricular Hypertrophy - Hypertens Res. 2008 Apr;31(4):615-22 - "Coronary flow velocity reserve (CFVR) ... CFVR was improved in the telmisartan group (2.4+/-0.4 to 2.9+/-0.4; p<0.01), but there was no difference in the nifedipine group (2.5+/-0.3 to 2.5+/-0.3; n.s.). HOMA-IR was improved in the telmisartan group (3.1+/-1.1 to 1.6+/-0.7; p<0.01), but there was no difference in the nifedipine group (2.8+/-1.1 to 2.4+/-0.7; n.s.). In conclusion, this study demonstrates that antihypertensive therapy with telmisartan, but not nifedipine, has a beneficial effect on coronary microcirculation and insulin resistance among essential hypertensive patients"
• Telmisartan but not candesartan affects adiponectin expression in vivo and in vitro - Hypertens Res. 2008 Apr;31(4):601-6 - "the changes in serum adiponectin and plasma glucose over 3 months were significantly greater in the telmisartan group than in the candesartan group. In vitro, although the protein level of adiponectin was not significantly elevated, the mRNA expression of adiponectin was elevated 1.5-fold by telmisartan in 3T3-L1 adipocytes. Our findings suggest that telmisartan may have beneficial effects in type 2 diabetes beyond its antihypertensive effect"
• Angiotensin receptor blockers in the treatment of NASH/NAFLD: Could they be a first-class option? - Adv Ther. 2008 Oct 29 - "Nonalcoholic fatty liver disease (NAFLD) ... nonalcoholic steatohepatitis (NASH) ... In our opinion there are two major advantages of ARBs that make them a possible therapeutic option for treating NASH and MS: their specific antihypertensive effect, and their impact on liver fibrosis. In light of this, and based on the current evidence (including existent human studies), we can speculate that some ARBs like telmisartan, candesartan, and losartan can be beneficial in treating NASH/NAFLD and its consequences, and further larger controlled clinical trials will bring consistent data into this field"
• Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome - Int J Impot Res. 2008 Jul 3 - "Erectile function increased significantly (P<0.0001) after 6 months of treatment with irbesartan, irrespective of dosage and independent of additional treatment with hydrochlorothiazide. Prevalence of ED declined to 63.7% from 78.5% at baseline, along with a significant increase in orgasmic function (P<0.001) and intercourse satisfaction (P<0.001). Treatment with irbesartan alone, as well as in combination with hydrochlorothiazide is associated with an improvement of sexual desire, frequency of sexual contacts and erectile function in hypertensive patients with the metabolic syndrome. These results suggest a beneficial role of angiotensin receptor antagonists in the treatment of metabolic syndrome, and ED" - Note:  I've been suggesting telmisartan (an ARB) for some time as the first line treatment for hypertension.
• Telmisartan-Hydrochlorothiazide Outperforms Valsartan-Hydrochlorothiazide for Blood Pressure Reduction - Doctor's Guide, 5/29/07 - "The change in diastolic blood pressure was -18.2 mmHg for the telmisartan-hydrochlorothiazide group and -17.0 mmHg for the valsartan-hydrochlorothiazide group. The change in systolic blood pressure was -24.6 mmHg and -22.5 for the two groups, respectively"
• Sustained Tubulo-interstitial Protection in SHRs by Transient Losartan Treatment: An Effect of Decelerated Aging? - Am J Hypertens. 2008 Jan 10 - "Transient losartan treatment reduces cell-turnover not only acutely but also for a prolonged period after drug withdrawal. This results in the long-term in reduced aging and attenuated tubulo-interstitial damage, suggesting there exists a modulating effect of angiotensin II (ANGII)-antagonism on long-term cell turnover" - Note:  Losartan is an ARB.  I would think that telmisartan (also and ARB and my recommendation for hypertension) would give the same effect.
• Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Inhibits Advanced Glycation End-product (AGE)-elicited Hepatic Insulin Resistance via Peroxisome Proliferator-activated Receptor-gamma Activation - J Int Med Res. 2008 Mar-Apr;36(2):237-43 - "Candesartan, another ARB, did not affect AGEs-induced serine phosphorylation of IRS-1 at serine-307 residues in Hep3B cells. Our study suggests that telmisartan could improve AGE-elicited insulin resistance in Hep3B cells by inhibiting serine phosphorylation of IRS-1, at least in part, via activation of PPAR-gamma"
• Metabolic effects of telmisartan and irbesartan in type 2 diabetic patients with metabolic syndrome treated with rosiglitazone - J Clin Pharm Ther. 2007 Jun;32(3):261-8 - "Telmisartan seemed to improve glycaemic and lipid control and metabolic parameters of the metabolic syndrome better than irbesartan. These differences could be relevant in the choice of therapy for this condition and diabetes"
• Meta-analysis of Randomized Controlled Trials Comparing Telmisartan With Losartan in the Treatment of Patients With Hypertension - Am J Hypertens. 2008 May;21(5):546-52. Epub 2008 Mar 20 - "In comparison with losartan, telmisartan provides superior control of BP and has no association with increased risk of adverse events"
• Telmisartan Superior to Ramipril in Preventing Morning Blood Pressure Rise - Doctor's Guide, 5/19/05 - "Reductions were greater and statistically significant in the highest quartile (34 mmHg), in whom telmisartan reduced systolic surge by 12.4 mmHg and ramipril by 7.1 mmHg"
• Telmisartan Provides Superior, Powerful Blood Pressure Reduction From Morning to Morning Compared to Other Leading ARBS - Doctor's Guide, 6/15/06 - "telmisartan provides superior, powerful blood pressure reduction from morning to morning compared to other leading angiotensin II receptor blockers"
• ONTARGET: ARB Similar to ACE - Medscape, 3/31/08 - "The angiotensin receptor blocker (ARB) telmisartan (Micardis, Boehringer Ingelheim) was "noninferior" to the ACE inhibitor ramipril in patients with vascular disease or high-risk diabetes in the landmark ONTARGET trial"
• The role of telmisartan in the treatment of metabolic syndrome - Ter Arkh. 2006;78(8):63-6 - "Telmisartan reduced all the study parameters of blood pressure, body mass, fasting and post-prandial hyperglycemia, postprandial hyperinsulinemia. Telmisartan raised peripheral tissue sensitivity to insulin, normalized phases of insulin secretion. Total cholesterol, LDLP cholesterol diminished while HDLP went up"
• Blood Pressure Drug Telmisartan Shows Powerful Activity Against Stroke, Study Suggests - Science Daily, 12/17/07 - "83 percent of rats given no medication showed signs of stroke, as did 56 percent of rats given ramipril alone. However, no strokes were noted in the telmisartan-only or the telmisartan/ramipril combo groups ... Telmisartan's ability to easily pass through the blood-brain barrier (something ramipril cannot do) is likely behind the neuroprotective effect noted in the study"
• Effects of telmisartan on fat distribution in individuals with the metabolic syndrome - J Hypertens. 2007 Apr;25(4):841-8 - "Systolic and diastolic blood pressure were decreased in both groups to a comparable level. However, insulin and glucose levels during an oral 75 g glucose loading were decreased only in the telmisartan group. The visceral fat area, determined by abdominal computed tomography scan, was reduced in the telmisartan group after 24 weeks' treatment, but the subcutaneous fat area did not change in either group"
• Bedtime Dosing of Atorvastatin and Valsartan Together Improves Overall Anti-Hypertensive Effects - Doctor's Guide, 5/17/05 - "When valsartan was dosed by itself during the day, patients averaged a 9 mmHg fall in systolic blood pressure; daytime dosing of both valsartan and atorvastatin resulted in a 17 mmHg reduction in the 24-hour mean of systolic and diastolic BP"
• Valsartan Appears More Effective Than Telmisartan in Patients With Essential Hypertension - Doctor's Guide, 6/25/04 - "At the end of the study, the 24-hour mean BP was statistically lower in the valsartan-treated group compared to telmisartan-treated group" - However:
  • Telmisartan Lowers Early Morning Blood Pressure in Patients With Hypertension More Effectively Than Does Valsartan - Doctor's Guide, 4/12/04 - "telmisartan reduced BP during the last 6 h of the dosing period more effectively than did valsartan (-11/-7.6 +/- 0.8/0.6 mm Hg vs. -8.7/-5.8 +/- 0.8/0.6 mm Hg"
• Metabolic Effect of Telmisartan [Micardis] and Losartan [Cozaar] in Hypertensive Patients with Metabolic Syndrome - Cardiovasc Diabetol. 2005 May 15;4(1):6 - "Telmisartan, but not losartan, significantly (p < 0.05) reduced free plasma glucose, free plasma insulin, homeostasis model assessment of insulin resistance and HbAic. Following treatment, plasma glucose and insulin were reduced during the oral glucose tolerance test by telmisartan, but not by losartan. Telmisartan also significantly reduced 24-hour mean systolic blood pressure (p < 0.05) and diastolic blood pressure (p < 0.05) compared with losartan"
• Effect of Telmisartan on Nitric Oxide-Asymmetrical Dimethylarginine System. Role of Angiotensin II Type 1 Receptor and Peroxisome Proliferator Activated Receptor {gamma} Signaling During Endothelial Aging - Hypertension. 2008 Feb 4 - "Telmisartan, in addition to blocking angiotensin (Ang) II type 1 receptor (AT1R), activates peroxisome proliferator activated receptor gamma (PPARgamma) signaling that interferes with nitric oxide (NO) system. Because aging of endothelial cells (ECs) is hallmarked by a reduction in NO synthesis, we hypothesized that telmisartan increases NO formation by regulated asymmetrical dimethylarginine (ADMA)-dimethylarginine dimethylaminohydrolase (DDAH)-system through blocking AT1R and activating PPARgamma signaling ... During the process of aging, PPARgamma protein expression decreased significantly, whereas the expression of AT1R increased. Telmisartan reversed these effects and dose-dependently decreased reactive oxygen species and 8-iso-prostaglandin (PG) F2alpha formation ... telmisartan mainly by activating PPARgamma signaling can alter the catabolism and release of ADMA as an important cardiovascular risk factor. We therefore propose that telmisartan translationally and posttranslationally upregulated DDAH expression via activation of PPARgamma signaling, causing ADMA to diminish and increase NO synthesis sufficient to delay senescence"
• Telmisartan But Not Valsartan Increases Caloric Expenditure and Protects Against Weight Gain and Hepatic Steatosis - Hypertension. 2006 Mar 27 - "Telmisartan, but not valsartan, promoted increases in caloric expenditure and protected against dietary-induced weight gain ... Telmisartan reduced the accumulation of visceral fat and decreased adipocyte size to a much greater extent than valsartan and was also associated with a significant reduction in hepatic triglyceride levels"
• Evidence-Based Treatment of Hypertension: What's the Role of Angiotensin II Receptor Blockers? - Medscape, 4/8/05 - "The ARBs are highly effective in lowering blood pressure and reducing cardiovascular mortality. They also appear to provide additional renal protection in patients with diabetes, and this effect is independent of their effect on blood pressure. Combinations of ARBs with drugs from other classes such as ACE inhibitors have been found to be highly effective; they may permit lower doses of ACE inhibitors to be used than in monotherapy, which may lower the incidence of dose-related adverse effects. The ARBs themselves are very well tolerated and are not associated with the side-effects known to cause compliance problems with beta blockers, ACE inhibitors and calcium channel blockers such as impotence, dry cough and peripheral oedema"
• Angiotensin II receptor blockers downsize adipocytes in spontaneously type 2 diabetic rats with visceral fat obesity - Am J Hypertens. 2007 Apr;20(4):431-6 - "adipocyte downsizing was significantly greater with telmisartan compared to valsartan. The likely mechanism for this difference was thought to be the PPAR-gamma-mediated action of telmisartan"
• The Differential Effects of Angiotensin II Type 1 Receptor Blockers on Microalbuminuria in Relation to Low-Grade Inflammation in Metabolic Hypertensive Patients - Am J Hypertens. 2007 May;20(5):565-72 - "There was a significant increase in high molecular weight adiponectin in the telmisartan group ... The reductions of microalbuminuria and high-sensitivity C-reactive protein (hs-CRP) were significant in the telmisartan group"
• Telmisartan shows an equivalent effect of vitamin C in further improving endothelial dysfunction after glycemia normalization in type 1 diabetes - Diabetes Care. 2007 Apr 24 - "Combining insulin and vitamin C normalized endothelial dysfunction and decreased oxidative stress to normal level. Telmisartan significantly improved basal endothelial function and decreased nitrotyrosine plasma levels. In patients treated with Telmisartan a near normalization of both flow mediated vasodilation and oxidative stress was achieved when glycemia was normalized, while adding vitamin C infusion did not show further effect on endothelial function or nitrotyrosine plasma levels"
• Telmisartan Reduces Proteinuria More Than Losartan - Doctor's Guide, 5/28/07 - "Our findings suggest that at similar levels of blood pressure control, telmisartan may confer greater protection against progression to end-stage renal disease"
• Preliminary Studies Suggest Potential Metabolic Effects of Micardis (Telmisartan) - Doctor's Guide, 9/9/05 - "The Micardis molecule is structurally similar to the PPAR-gamma activator, pioglitazone,3 which has been approved for the treatment of type 2 diabetes.7 Micardis partially activates PPAR-gamma resulting in metabolic effects that differentiate it from other ARBs, according to preclinical data.1-4 These data demonstrate that Micardis has a beneficial effect on insulin resistance and blood lipids, independent of its effect on the renin-angiotensin-aldosterone system"
• Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin-resistance, leptin and tumor necrosis factor-alpha - Hypertens Res. 2006 Nov;29(11):849-56 - "The decrease in HbA1c and FPG at 12 months was statistically significant only in the telmisartan group"
• Novel ARB Provides Greater Reductions in Proteinuria in Diabetics With Overt Nephropathy - Medscape, 5/22/07 - "One year of treatment with the novel angiotensin receptor blocker (ARB) telmisartan provided greater reductions in proteinuria when compared with losartan, a drug approved for the treatment of diabetic nephropathy to prevent renal-disease progression"
• New treatment strategies for patients with hypertension and insulin resistance - Am J Med. 2006 May;119(5 Suppl 1):S24-30 - "the ability of telmisartan both to activate PPAR-gamma and to block the angiotensin receptor may provide added value not only in the treatment of the metabolic syndrome and prevention of type 2 diabetes but also in prevention and treatment of atherosclerotic cardiovascular disease"
• Angiotensin II Antagonist Telmisartan Fights Stiffening Arteries In Hypertensive Diabetics - Doctor's Guide, 4/6/01 - "not only effectively lowered blood pressure compared with placebo, but also significantly decreased arterial stiffness"
• The effects of telmisartan and amlodipine on metabolic parameters and blood pressure in type 2 diabetic, hypertensive patients - J Renin Angiotensin Aldosterone Syst. 2006 Dec;7(4):243-6 - "Group A: rosiglitazone (RSG) 4 mg + Telm 80 mg; Group B: RSG 4 mg + Aml 10 mg ... Lower values of glucose, HbA1C, HOMA index and higher adiponectin levels were observed in Group A compared to Group B ... insulin sensitivity may confer make Telm particularly suitable in the treatment of the metabolic syndrome"
• The effects of irbesartan and telmisartan on metabolic parameters and blood pressure in obese, insulin resistant, hypertensive patients - J Endocrinol Invest. 2006 Dec;29(11):957-61 - "The greater impact on the improvement of the metabolic profile showed by telmisartan and the inverse correlation between adiponectin levels and blood pressure may be partly due to the action as partial PPARgamma agonist displayed by telmisartan"
• BP Lowering May Halt Descent Into Dementia - Clinical Psychiatry News, 12/02 - "those in the candesartan arm had a mean 0.5-point decline in MMSE scores during follow-up, compared with a 6-point drop in those on a diuretic. The cognitive benefit was even more pronounced in patients over age 85" - Does this pertain to other ARBs?  I don't know.
• Dyslipidemia and Concurrent Medications Improve Likelihood of Persistence to ACE Inhibitor Therapy - Doctor's Guide, 10/27/05 - "The adjusted rate ratio of therapy discontinuation was consistently higher for all other ACE inhibitors relative to ramipril"
• Telmisartan May Help Preserve Renal Function in Patients With Hypertension, Diabetes - Medscape, 6/1/07 - "In patients with hypertension and type 2 diabetes, telmisartan and ramipril both may help preserve cardiovascular and renal function by increasing nitric oxide (NO) activity of the renal endothelium"
• Telmisartan Provides Superior, Powerful Blood Pressure Reduction From Morning to Morning Compared to Other Leading ARBS - Doctor's Guide, 6/15/06 - "telmisartan provides superior, powerful blood pressure reduction from morning to morning compared to other leading angiotensin II receptor blockers"
• Telmisartan Lowers Early Morning Blood Pressure in Patients With Hypertension More Effectively Than Does Valsartan - Doctor's Guide, 4/12/04 - "telmisartan reduced BP during the last 6 h of the dosing period more effectively than did valsartan (-11/-7.6 +/- 0.8/0.6 mm Hg vs. -8.7/-5.8 +/- 0.8/0.6 mm Hg"
• Vitamin C 'benefits diabetics' - BBC News, 6/28/07 - "Vitamin C neutralises free radicals, while Telmisarten stimulates the natural removal of the molecules by cells"
• Telmisartan, an Angiotensin II Type 1 Receptor Blocker, Inhibits Advanced Glycation End-product (AGE)-induced Monocyte Chemoattractant Protein-1 Expression in Mesangial Cells Through Downregulation of Receptor for AGEs via Peroxisome Proliferator-activated Receptor-gamma Activation - J Int Med Res. 2007 Jul-Aug;35(4):482-9 - "Candesartan, an Ang II type 1 receptor blocker, did not suppress AGEs-induced superoxide generation. Telmisartan and the antioxidant, N-acetylcysteine, completely inhibited AGEs-induced MCP-1 overproduction by mesangial cells"

Arguments for Ramipril:

• Effects of Ramipril on Endothelial Function and the Expression of Proinflammatory Cytokines and Adhesion Molecules in Young Normotensive Subjects With Successfully Repaired Coarctation of Aorta A Randomized Cross-Over Study - J Am Coll Cardiol. 2008 Feb 19;51(7):742-749 - "Ramipril reversed the impaired endothelial function and decreased the expression of proinflammatory cytokine IL-6, sCD40L, and adhesion molecules in normotensive subjects with SCR. These findings imply that ramipril treatment may have antiatherogenic effects in subjects with SCR, even in the absence of arterial hypertension"
• Keeping Seniors Independent - WebMD, 3/14/02 - "the average three-year decline in walking speed among those women who used ACE inhibitors was 10 times lower than it was in the other groups ... Researchers think several factors may explain these drugs' beneficial effect on delaying disability: ACE inhibitors increase blood flow to the muscles, reduce inflammation, and promote healthy eating habits and better nutrition by inhibiting a substance known to reduce appetite"
• Blood Pressure Drugs May Help People Avoid 'Type 2' Disease, but Healthy Habits Still Best - WebMD, 10/16/01 - "people at high risk for developing diabetes who take the drug Altace [ramipril] were 34% less likely to develop diabetes than those who did not get the drug"
• Not All ACE Inhibitors Have the Same Effect on Mortality - Medscape, 7/28/04 - "enalapril, fosinopril, captopril, quinapril, and lisinopril were associated with higher mortality than was ramipril"
• Angiotensin-converting Enzyme Inhibitors, Beta Blockers May Postpone Kidney Failure - Doctor's Guide, 10/13/00 - "The ACE inhibitor ramipril (Altace®) or the beta-blocker metoprolol (Toprol®) significantly reduced the risk of kidney failure compared to the CCB amlodipine (Norvasc®) in a group of patients who had at least one gram of protein in a 24-hour sample of urine when they joined the African American Study of Kidney Disease and Hypertension (AASK). Blood pressures were comparable."
• Ramipril Reduces Advanced Glycation End Products In Non-Diabetic Nephropathy - Doctor's Guide, 4/21/03 - "Ramipril also mildly decreased levels of advanced glycation end products"
• Some Hypertension Drugs May Help Reduce Dementia Risk - Science Daily, 5507 - "Centrally acting drugs include captropril (Capoten®), fosinopril (Monopril®), lisinopril (Prinivil® or Zestri®), perindopril (Aceon®), ramipril (Altace®) and trandolapril (Mavik®) ... The study found a link between taking centrally active ACE inhibitors and lower rates of mental decline as measured by the Modified Mini-Mental State Exam, a test that evaluates memory, language, abstract reasoning and other cognitive functions"
• Effect of antihypertensive agents on plasma adiponectin levels in hypertensive patients with metabolic syndrome - Nephrology (Carlton). 2007 Apr;12(2):147-53 - "Ramipril and valsartan increased the plasma adiponectin levels significantly higher than the other regimens"
• BP Reduction in the Metabolic Syndrome and Type 2 Diabetes - Medscape, 2/13/06 - "Beta blockers are now widely regarded as having worse outcomes than other major classes of antihypertensive agents, though this view is heavily influenced by a single drug, atenolol.[29] Furthermore, the thiazide/beta blocker combination has been associated with an increased risk of the emergence of new-onset diabetes.[30] This has been strongly reinforced by the ASCOT trial, where the likelihood of new diabetes was 30% greater in the thiazide/beta blocker patients as compared to those taking calcium channel blockers with an ACE inhibitor.[31] Conversely, a very recent meta-analysis has shown that overall ACE inhibitors and ARBs reduce the risk of diabetes by about 25%"
• Blood Pressure Drugs Counter Cancer? - WebMD, 5/23/06 - "After crunching the numbers, the risk reduction in veterans taking ACE inhibitors was 53% for colon cancer, 52% for pancreatic cancer, and 46% for esophageal cancer"
• Prevention of Type 2 diabetes: fact or fiction? - Expert Opin Pharmacother. 2007 Dec;8(18):3147-58 - "the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study (n = 5269) demonstrated that rosiglitazone at 8 mg once/day in subjects with prediabetes (IGT and/or impaired fasting glucose) was effective in reducing the risk of diabetes by 60%"
• Keeping Seniors Independent - WebMD, 3/14/02 - "the average three-year decline in walking speed among those women who used ACE inhibitors was 10 times lower than it was in the other groups ... Researchers think several factors may explain these drugs' beneficial effect on delaying disability: ACE inhibitors increase blood flow to the muscles, reduce inflammation, and promote healthy eating habits and better nutrition by inhibiting a substance known to reduce appetite"
• ACE Inhibitors May Protect Against Mental Decline - Clinical Psychiatry News, 8/07 - "The group of patients on an antihypertensive other than an ACE inhibitor had a mean decline in exam scores of 0.64 points per year. Those on an ACE inhibitor had a mean decline of 0.38 points per year ... It is thought that some ACE inhibitors protect from dementia and mental decline by decreasing oxidative stress and inflammation in the brain"

Arguments for/against combining ARBs and ACE inhibitors:

• Combining ACE Inhibitors With Angiotensin Receptor Blockers May Not Be Optimal for Treating Hypertension - Doctor's Guide, 5/11/09
• Beneficial Effects of Combination Therapy with Angiotensin II Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor on Vascular Endothelial Function - Hypertens Res. 2008 Aug;31(8):1603-10 - "these results suggest that the angiotensin I-converting enzyme inhibitor perindopril is superior to the calcium channel blocker amlodipine for reducing vascular endothelial dysfunction when co-administered with angiotensin receptor blockers in patients with essential hypertension"
• Use of Combination ACE Inhibitors and ARB Therapy in Patients With CKD - Medscape, 9/29/08
• Effects of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Antagonist Combination on Nitric Oxide Bioavailability and Atherosclerotic Change in Watanabe Heritable Hyperlipidemic Rabbits - Hypertens Res. 2008 Mar;31(3):575-84 - "1) vehicle (control), 2) the ACEI enalapril (E: 3 mg/kg/day), 3) the ARB losartan (L: 30 mg/kg/day) and 4) enalapril (1.5 mg/kg/day) + losartan (15 mg/kg/day) (E+L). Intra-aortic infusion of ACh produced an increase in plasma NO concentration, which was significantly greater with all the drug treatments than with the control. E increased ACh-induced NO significantly more than L (by 6.9 nmol/L, and 4.7 nmol/L, respectively). E+L increased ACh-induced NO by 9.5 nmol/L, significantly more than either E or L ... the combined treatment with an ACEI and an ARB may have additive protective effects on endothelial function as well as atherosclerotic change"
• Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, or Both for Patients With Proteinuria? A Best Evidence Review - Medscape, 5/20/08 - "Most significantly, the addition of ACEIs to ARBs reduced proteinuria to a greater degree than ARBs alone (ratio of means 0.76 at 1 to 4 months and 0.75 at 5 to 12 months). Combination therapy was also superior to treatment with ACEIs alone ... The 2 important conclusions that can be drawn from this meta-analysis are that ARBs are not superior to ACEIs in improving proteinuria, and that the combination of these 2 treatments appears superior in this outcome compared with either treatment alone ... Two of the biggest safety concerns regarding the combination therapy include the risks for hyperkalemia and acute worsening of renal function. A review of the literature, however, suggests that these risks may not be significantly worse with combination treatment vs monotherapy"
• ACE Inhibitors Plus ARBs Reduce Proteinuria But Increase Kidney Damage - Doctor's Guide, 8/15/08 - "in people at high vascular risk, telmisartan's effects on major renal outcomes are similar to [those of] ramipril. Although combination therapy reduces proteinuria to a greater extent than monotherapy, overall it worsens major renal outcomes"
• Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events - N Engl J Med. 2008 Mar 31 - "Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit" - Yeah but if you have to go with two drugs it sure seems like it's the least of all the evils regarding side effects.
• ACE Inhibitors May Protect Diabetics From Cancer, Peptic Ulcer - Medscape, 12/19/08 - "There was a significant association between ACE inhibitor use and the risk for cancer, with an adjusted odds ratio of 0.59 ... The rate of cancer among users of ACE inhibitors was 10% vs 15% for nonusers ... There was also a significant association between ACE inhibitor use and peptic ulcer disease, with an odds ratio of 0.68 ... The rate of peptic ulcer disease among ACE inhibitor users was 12% vs 16% among nonusers"
• Establishing A New Option for Target-organ Protection: Rationale for ARB Plus ACE Inhibitor Combination Therapy - Am J Hypertens. 2008 Jan 24 - "Combination therapy targeting RAS activation may reduce target-organ damage and provide superior blood pressure (BP) control; combining angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) represents one possible approach"
• Rationale for double renin-angiotensin-aldosterone system blockade - Am J Cardiol. 2007 Aug 6;100(3A):25J-31J - "The clinical benefits of both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) extend beyond blood pressure reduction to encompass tissue-protective effects in target organs, such as the heart, vasculature, and kidneys, that underlie the reductions in cardiovascular mortality and morbidity seen in large outcome trials. However, these effects are achieved by different mechanisms. ACE inhibitors reduce circulating and tissue angiotensin II levels and potentiate the beneficial effects of bradykinin, including generation of nitric oxide (NO). By contrast, the protective effects of ARBs are owing to the blockade of the angiotensin II type 1 (AT(1)) receptors and possibly also to the stimulation of angiotensin II type 2 (AT(2)) receptors, again resulting in NO release. In addition, some ARBs, such as telmisartan, are selective activators of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), thereby increasing insulin sensitivity. In contrast to other PPAR-gamma ligands, such as the thiazolidinediones, activation of this receptor by telmisartan does not result in weight gain. The complementary mechanisms of action of ACE inhibitors and ARBs create a rationale for combination therapy in high-risk patients"
• New opportunities in cardiovascular patient management: a survey of clinical data on the combination of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers - Am J Cardiol. 2007 Aug 6;100(3A):45J-52J - "Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) differ in their actions on the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors prevent the formation of angiotensin II, although angiotensin II may still be generated by alternative pathways. However, ACE inhibitors interrupt bradykinin breakdown, which in turn potentially enhances nitric oxide and prostacyclin mechanisms. In contrast, ARBs selectively prevent the binding of angiotensin II to the angiotensin type 1 (AT(1)) receptor while leaving the potentially beneficial effects of the AT(2) receptor unaffected. The supposition is that dual blockade of the RAAS effectively overcomes the harmful effects of angiotensin II mediated by the AT(1) receptor while offering the additional effects of the ACE inhibitor"
• Do we use an ACE, an ARB, or both? What clinical trials tell us - Patient Care, 4/1/05 - "Combining ACEs and ARBs can improve outcomes, particularly for patients with heart failure and those who have hypertension with diabetes"
• Impact of Telmisartan Versus Ramipril on Renal Endothelial Function in Patients with Hypertension and Type 2 Diabetes - Diabetes Care. 2007 Mar 2 - "In patients with type 2 diabetes telmisartan and ramipril both increased NO activity of the renal endothelium significantly that in turn may support the preservation of cardiovascular and renal function"
• Addition of an angiotensin receptor blocker to full-dose ACE-inhibition: controversial or common sense? - Eur Heart J. 2005 Nov;26(22):2361-7 - "combination of a full-dose ACE-inhibitor and an ARB can be a rational choice in selected patients" - [full article]
• Combination ACE inhibitor and angiotensin receptor blocker therapy - future considerations - J Clin Hypertens (Greenwich). 2007 Jan;9(1):78-86. - "The individual gains seen with each of these drug classes have led to speculation that their combination might offer additive if not synergistic outcome benefits. The foundation of this hypothesis, although biologically possible, has thus far not been sufficiently well proven to support the everyday use of these 2 drug classes in combination. Additional outcomes trials, which are currently proceeding to their conclusion, may provide the necessary proof to support an expanded use of these 2 drug classes in combination"
• Do ACE inhibitors and ARBs mix well? Analysis urges caution - theheart.org, 10/10/07 - "patients receiving both an ACE inhibitor and an ARB were more likely not to comply with therapy due to side effects, which included hypotension, cough, angioedema, worsening renal function as defined by a change in serum creatinine >0.5 mg/dL, hyperkalemia as defined by serum potassium level changes >5.5 mEq/L, and symptomatic hypotension"
• See telmisartan and ramipril at OffshoreRx1.com.

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