Hypertension Research (2018) 41:394–405
The role of the angiotensin II type I receptor blocker telmisartan in
the treatment of non-alcoholic fatty liver disease: a brief review
Luciana M. A. Borém
João F. R. Neto
Igor V. Brandi
Deborah F Lelis
Sergio H. S. Santos
Received: 9 June 2017 / Revised: 31 October 2017 / Accepted: 17 November 2017 / Published online: 10 April 2018
© The Japanese Society of Hypertension 2018
Non-alcoholic fatty liver disease (NAFLD) is currently considered an important component of metabolic syndrome (MetS).
The spectrum of NAFLD includes conditions that range from simple hepatic steatosis to non-alcoholic steatohepatitis.
NAFLD is correlated with liver-related death and is predicted to be the most frequent indication for liver transplantation by
2030. Insulin resistance is directly correlated to the central mechanisms of hepatic steatosis in NAFLD patients, which is
strongly correlated to the imbalance of the renin–angiotensin system, that is involved in lipid and glucose metabolism.
Among the emerging treatment approaches for NAFLD is the anti-hypertensive agent telmisartan, which has positive effects
on liver, lipid, and glucose metabolism, especially through its action on the renin–angiotensin system, by blocking the ACE/
AngII/AT1 axis and increasing ACE2/Ang(1–7)/Mas axis activation. However, treatment with this drug is only
recommended for patients with an established indication for anti-hypertensive therapy. Thus, there is an increased need for
large randomized controlled trials with the aim of elucidating the effects of telmisartan on liver disease, especially NAFLD.
From this perspective, the present review aims to provide a brief examination of the pathogenesis of NAFLD/NASH and the
role of telmisartan on preventing liver disorders and thus to improve the discussion on potential therapies.
Diet and lifestyle changes have led to a worldwide increase
in the prevalence of metabolic syndrome (MetS), a complex
disorder in which obesity, glucose intolerance, insulin
resistance (IR), dyslipidemia, and hypertension are asso-
ciated [1–3]. Non-alcoholic fatty liver disease (NAFLD) is
now considered a hepatic component of MetS because of
the close association between the two conditions, which
share the same risk factors [3–6].
NAFLD is currently the most common liver disorder
[7–9], with a prediction to be the most frequent indication
for liver transplantation by 2030 . The global estimated
prevalence of NAFLD ranges from 6.3 to 33% in the gen-
eral population with a median prevalence of 20%, the
median prevalence is higher in developed countries [8–10].
NAFLD is deﬁned as a lipodystrophy with lipid-deposit
accumulation in the hepatocytes accounting for more than
5–10% of the total hepatic weight, which is not due to
excessive alcohol use (women ≤ 20 g/d, men ≤ 30 g/d). An
accurate diagnosis requires imaging or histological techni-
ques, and secondary causes of hepatic steatosis should be
excluded, such as drugs, hepatitis C virus, surgical proce-
dures, total parenteral nutrition, and various innate meta-
bolism disorders [5, 9].
NAFLD is a term that encompasses the entire spectrum
of this disease, ranging from simple steatosis to non-
alcoholic steatohepatitis (NASH), which can lead to life-
threatening hepatic cirrhosis and hepatocellular carcinoma
in its most severe form [4, 6, 9, 11]. Histologically, NASH
is characterized by hepatic steatosis and signs of intra-
lobular inﬂammation with ballooning degeneration of the
hepatocytes. The estimated prevalence of NASH is much
lower than NAFLD and ranges from 3 to 5% [9, 10].
Twenty percent of NASH patients are reported to develop
* Sergio H. S. Santos
Laboratory of Health Science, Postgraduate Program in Health
Sciences, Universidade Estadual de Montes Claros (Unimontes),
Montes Claros, Minas Gerais, Brazil
Medicine Department, Faculdades Integradas Pitágoras,
Montes Claros, Minas Gerais, Brazil
Institute of Agricultural Sciences, Food Engineering College,
Universidade Federal de Minas Gerais (UFMG), Montes Claros,
Minas Gerais, Brazil