Role of RAAS and adipokines in cardiovascular protection: effect of different doses of angiotensin II receptor blocker on adipokines level in hypertensive patients

The present study was designed to determine the effect of different doses of the angiotensin II receptor blocker (ARB), candesartan, on circulating adiponectin and leptin levels as well as leptin adiponectin ratio (LAR) in hypertensive patients with multiple cardiovascular risk factors.Sixty-nine hypertensive patients were randomized to three groups: group 1 included patients treated with high doses of Candesartan (32 mg); group 2 included patients treated with conventional doses of Candesartan (16 mg); and group 3 included patients that received antihypertensive treatment other than ARBs or angiotensin-converting-enzyme inhibitors. Patients were evaluated for lipid profile, HbA1C, insulin, C-peptide, c-reactive protein, aldosterone, renin, Homeostasis model assessment-insulin resistance, leptin, adiponectin and LAR. Baseline adiponectin, leptin, and LAR levels did not differ significantly between the three groups. After 6 months of treatment, LAR was significantly higher in group 3 than group 1 (P = .007) or group 2 (P = .023). Differences between effects of high (32 mg) and conventional doses (16 mg) of Candesartan on LAR were not observed (P = .678). Marginal across-group differences were detected for posttreatment circulating adiponectin level (P = .064). Univariate general linear model (GLM) analysis of posttreatment LAR detected significant by-group differences even after adjustment for age, gender, baseline values of LAR, and blood pressure. In this model, group was the only significant predictor of LAR after controlling for these variables. Treatment with high doses of the ARB, candesartan, is associated with significantly reduced LAR and marginally increased circulating adiponectin levels in hypertensive patients with multiple cardiovascular risk factors.