***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Few studies have analyzed intraclass differences in angiotensin II receptor blockers ( ARBs ) with respect to antidiabetic or metabolic effects . We design ed a prospect i ve r and omized study to compare a peroxisome proliferator-activated receptor-gamma (PPARgamma)-activating ARB with a nonactivating ARB to delineate the effects on metabolic factors associated with cardiovascular disease . Subjects initially comprised 153 hypertensive patients ( 72 men , 81 women ; mean age , 67.9 + /- 7.8 years ) with diagnosed glucose intolerance on the glucose loading test . Patients were r and omly assigned to receive 6-month administration of telmisartan 47.0 mg/d ( TEL ) or c and esartan 8.4 mg/d ( CAN ) , or to have no change in drug regimen ( control group , CTL ) . Fasting plasma glucose level was significantly reduced in TEL ( n = 46 ) compared with CTL ( n = 47 ) ( percentage of change from baseline , -1.7 % vs + 2.2 % ; P = .045 ) . Percentage of increase in adiponectin was significantly larger in TEL than in CTL ( + 10.5 % vs + 2.2 % , P = .025 ) , but not significantly larger in CAN ( n = 44 ) than in CTL ( + 4.9 % vs + 2.2 % ; P = .13 ) . Percentage of decrease in body weight from baseline was significantly enhanced in TEL compared with CTL ( -2.2 % vs -0.8 % , P = .023 ) and CAN ( -2.2 % vs -0.3 % , P = .007 ) . Telmisartan decreased body weight while increasing serum adiponectin levels in hypertensive patients with glucose intolerance . C and esartan 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 Aim . This study compared the effects of telmisartan and losartan on  nonalcoholic fatty liver disease ( NAFLD )  and biochemical markers of insulin resistance in hypertensive NAFLD patients with type 2 diabetes mellitus . Methods . This was a r and omized , open-label , parallel-group comparison of therapy with telmisartan or losartan .  Nineteen hypertensive NAFLD patients with type 2 diabetes were r and omly assigned to receive telmisartan at a dose of 20 mg once a day ( n = 12 ) or losartan at a dose of 50 mg once a day ( n = 7 ) for 12 months . Body fat area as determined by CT scanning and hepatic fat content based on the liver-to-spleen ( L/S ) ratio , as well as several parameters of glycemic and lipid metabolism , were compared before and after 12 months . Results . The telmisartan group showed a significant decline in serum free fatty acid ( FFA ) level ( from 0.87 ± 0.26 to 0.59 ± 0.22 mEq/L ( mean ± SD ) , P = 0.005 ) and a significant increase in L/S ratio ( P = 0.049 ) evaluated by CT scan , while these parameters were not changed in the losartan group . Conclusion . Although there was no significant difference in improvement in liver enzymes  with telmisartan and losartan treatment in hypertensive NAFLD patients with type 2 diabetes after 12 months , it is suggested that telmisartan may exert beneficial effects by improving fatty liver To examine the effects of telmisartan on peroxisome proliferator – activated receptor γ activation , we compared the effects of telmisartan with those of c and esartan on adipocytokines and glucose and lipid metabolism in vivo and in vitro . In vivo , 56 patients with both type 2 diabetes and hypertension were enrolled and r and omized to receive either telmisartan ( 40 mg ) or c and esartan ( 8 mg ) for 3 months . Serum adiponectin , HbA1c levels , lipid profiles and blood pressure were recorded at the beginning and 3 months later . In vitro , differentiated 3T3-L1 adipocytes were treated with telmisartan , c and esartan , pioglitazone or vehicle for 24 h , and then adiponectin mRNA and protein levels were measured . The results showed that most of the metabolic parameters , including the lipid profiles , did not change significantly during the study in either group . However , the changes in serum adiponectin and plasma glucose over 3 months were significantly greater in the telmisartan group than in the c and esartan 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 OBJECTIVE PPARgamma agonists are widely used in type 2 diabetic patients to reduce insulin resistance . Recently , telmisartan , an AT1 receptor antagonist , was reported to function as a partial agonist of PPARgamma based on in vitro experiments . The aim of the present study was to investigate whether the PPARgamma enhancing activity of telmisartan is exerted clinical ly in diabetic patients . METHODS We compared the effects of telmisartan with those of c and esartan , on insulin sensitivity , the serum levels of various adipocytokines and oxidative stress . PATIENTS In total , 85 Japanese type 2 diabetic patients with hypertension , maintained on 8 mg per day of c and esartan , were r and omly assigned to the TM group ( c and esartan switched to 40 mg of telmisartan , n=38 ) or the CD group ( no treatment change , n=47 ) . RESULTS After 3 months , oxidized lipids were significantly decreased only in the TM group . Although the homeostasis assessment model of insulin resistance ( HOMA-R ) tended to be improved and serum concentrations of HDL-cholesterol and HMW adiponectin tended to be increased only in the TM group , these alterations were too small to be significant by unpaired t-test . Interestingly , in subgroup analysis , the alterations of HOMA-R , serum concentrations of oxidized lipids , and HMW adiponectin were more apparent in obese TM group subjects and the changes reached statistical significance . CONCLUSION Switching from c and esartan to telmisartan in obese subjects increases serum adiponectin and improves both insulin resistance and oxidative stress , while these effects were not statistically apparent in the total patient population . These results support the idea that telmisartan exerts its PPARgamma enhancing activity clinical ly in obese type 2 diabetic patients Background : There is increasing evidence that inhibition of the renin-angiotensin system provides renoprotection independent of blood pressure lowering . The aim of the present study was to determine whether various angiotensin II receptor blockers ( ARBs ) affect urinary albumin excretion ( UAE ) , urinary liver-type fatty acid-binding protein ( L-FABP ) and 8-hydroxy-2′-deoxyguanosine ( 8-OHdG ) levels in early-stage diabetic nephropathy patients with microalbuminuria . Methods : Sixty-eight diabetic nephropathy patients with microalbuminuria were r and omly allocated to 1 of 4 treatment groups : losartan 100 mg/day ( group A ) , c and esartan 12 mg/day ( group B ) , olmesartan 40 mg/day ( group C ) , or telmisartan 80 mg/day ( group D ) . Treatment was continued for 12 months . UAE , L-FABP and 8-OHdG excretion , serum creatinine , and 24-hour creatinine clearance ( Ccr ) were measured . Results : The serum creatinine and 24-hour Ccr were not affected during the experimental period in any of the groups . Systolic and diastolic blood pressures , UAE , urinary L-FABP and 8-OHdG excretion were significantly reduced after 6 and 12 months compared with baseline in any of the groups . ΔL-FABP and Δ8-OHdG were significantly greater in group D than in the other 3 groups after 12 months . Conclusions : ARBs have renoprotection and this effect of telmisartan appears to be more potent than that of losartan , c and esartan , or olmesartan in early-stage diabetic nephropathy patients AIM To evaluate insulin resistance , cytolysis and non-alcoholic steatohepatitis ( NASH ) score ( NAS ) using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension , treated with telmisartan vs valsartan for 20 mo . METHODS All patients met the NCEP-ATP III criteria for metabolic syndrome . Histology confirmed steatohepatitis , defined as a NAS greater than five up to 3 wk prior inclusion , using the current criteria . Patients with viral hepatitis , chronic alcohol intake , drug abuse or other significant immune or metabolic hepatic pathology were excluded . Subjects were r and omly assigned either to the valsartan ( V ) group ( st and ard dose 80 mg o.d . , n = 26 ) , or to the telmisartan ( T ) group ( st and ard dose 20 mg o.d . , n = 28 ) . Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed . Neither the patient nor the medical staff was aware of treatment group allocation . Paired liver biopsies obtained at inclusion ( visit 1 ) and end of treatment ( EOT ) were assessed by a single blinded pathologist , not aware of patient or treatment group . Blood pressure , BMI , ALT , AST , HOMA-IR , plasma triglycerides ( TG ) and total cholesterol ( TC ) were evaluated at inclusion and every 4 mo until EOT ( visit 6 ) . RESULTS At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T , the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH .  Telmisartan showed a higher efficacy regarding insulin resistance and histology , perhaps because of its specific PPAR-gamma lig and effect OBJECTIVE To investigate the effects of telmisartan on body fat distribution and insulin sensitivity in patients with hypertension and obesity . METHODS In this prospect i ve , r and omized study , out patients from the Sixth People 's Hospital affiliated to Shanghai Jiaotong University , Shanghai , China were treated with telmisartan  ( n=23 ) , or losartan  ( n=22 ) for 16 weeks between December 2009 to January 2011 . Parameters such as waist and hip circumference , body mass index , fasting blood glucose , insulin , lipids , serum adiponectin , and tumor necrosis factor-alpha ( TNF-alpha ) were measured before and after treatment . The abdominal visceral fat area ( VFA ) and subcutaneous fat area ( SFA ) were determined by magnetic resonance imaging . Insulin sensitivity was estimated by homeostasis model assessment ( HOMA-IR ) . RESULTS Compared with baseline , the systolic and diastolic blood pressure decreased significantly in both groups . However , the levels of HOMA-IR , serum adiponectin , and TNF-alpha only improved in the telmisartan group . Similarly , the VFA was reduced in the telmisartan group , while the SFA did not change in either group . CONCLUSION Telmisartan improves both hemodynamic and metabolic abnormalities found in hypertensive patients with obesity . The additional benefits may be partly due to visceral fat remodeling Introduction The number of patients with both hypertension and obesity has been increasing in Japan . Many of these patients may also have insulin resistance . Telmisartan , an angiotensin II receptor blocker ( ARB ) , selectively activates peroxisome proliferatoractivated receptor (PPAR)-gamma , and this effect is considered to markedly improve insulin resistance in obese patients with hypertension . We compared the antihypertensive and insulin resistance-improving effects of telmisartan with those of c and esartan and valsartan in this patient population . Methods Twenty-eight elderly patients with an average body mass index ( BMI ) of 27.1 kg/m2 were enrolled in this 6-month study . Patients were r and omly selected to either switch from c and esartan or valsartan to telmisartan or to continue with their current ARB . A 75 g oral glucose tolerance test ( OGTT ) was performed before and after switching , and the effect of telmisartan on the insulin response to glucose loading was investigated . Results There was no significant difference in blood pressure between the two groups after drug administration , but glucose tolerance significantly improved in the telmisartan group . The hyperinsulin response to glucose loading also significantly improved in those taking telmisartan , as well as homeostasis model assessment of insulin resistance ( HOMA 
    Output:
    
Conclusion : Telmisartan can better improve IR compared with other ARBs