Risk of New-Onset Diabetes Mellitus and Cardiovascular Outcomes of Telmisartan in Hypertensive Patients

Background: Telmisartan, a widely used angiotensin II receptor blocker (ARB) with partial peroxisome proliferator-activated receptor-gamma (PPAR-γ) activity, may confer additional cardiovascular and metabolic benefits. However, evidence comparing telmisartan with other ARBs in terms of major cardiovascular outcomes and risk of new-onset diabetes remains limited Method: 59767 patients with hypertension and ARB use between January 1, 2007 to December 31, 2017 were identified from the Chang Gung Research Database (CGRD), a multi-institutional electronic medical record database in Taiwan. Patients prescribed telmisartan or other ARBs for at least six months were included. Propensity score matching (1:4) was applied to balance baseline characteristics. Primary outcomes were new-onset diabetes mellitus(DM), major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, non-fatal stroke and CV death) and all cause mortality.Secondary outcomes include hospitalization for heart failure and malignancy.The risks of new-onset DM, MACE, and mortality were compared between two groups using Cox proportional hazards models. In addition, we performed analyzes using Fine and Gray sub-distribution hazard models that considered death a competing risk. Result: A total of 15,160 patients (telmisartan: 3,032; other ARBs: 12,128) were included after matching. Telmisartan users had a significantly lower risk of 3P-MACE (aHR 0.88, 95% CI 0.80–0.97, p = 0.0074) and non-fatal MI (aHR 0.68, 95% CI 0.52–0.90, p = 0.006) compared to other ARB users. No significant differences were observed for new-onset DM (aHR 1.06, 95% CI 0.88–1.28, p = 0.54), cardiovascular death (aHR 0.86, 95% CI 0.62–1.18, p = 0.35), or other outcomes such as stroke or hospitalization for heart failure. Conclusion: Telmisartan is associated with superior cardiovascular protection which mainly attributed to reducing risks of non-fatal MI compared to other ARBs, while exhibiting a neutral effect on risk of new-onset DM. These findings suggest telmisartan may be a preferred ARB for hypertensive patients at high cardiovascular risk. Further prospective studies are warranted to validate these results and explore the underlying mechanisms.