Effect of Telmisartan on Walking Performance in Patients with Lower Extremity Peripheral Artery Disease: The TELEX Randomized Clinical Trial

Mary M. McDermott, Lydia Bazzano, Charlotte A. Peterson, Robert Sufit, Luigi Ferrucci, Kathryn Domanchuk, Lihui Zhao, Tamar S. Polonsky, Dongxue Zhang, Donald Lloyd-Jones, Christiaan Leeuwenburgh, Jack M. Guralnik, Melina R. Kibbe, Kate Kosmac, Michael H. Criqui, Lu Tian

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Importance: Patients with lower extremity peripheral artery disease (PAD) have reduced lower extremity perfusion, impaired lower extremity skeletal muscle function, and poor walking performance. Telmisartan (an angiotensin receptor blocker) has properties that reverse these abnormalities. Objective: To determine whether telmisartan improves 6-minute walk distance, compared with placebo, in patients with lower extremity PAD at 6-month follow-up. Design, Setting, and Participants: Double-blind, randomized clinical trial conducted at 2 US sites and involving 114 participants. Enrollment occurred between December 28, 2015, and November 9, 2021. Final follow-up occurred on May 6, 2022. Interventions: The trial randomized patients using a 2 × 2 factorial design to compare the effects of telmisartan plus supervised exercise vs telmisartan alone and supervised exercise alone and to compare telmisartan alone vs placebo. Participants with PAD were randomized to 1 of 4 groups: Telmisartan plus exercise (n = 30), telmisartan plus attention control (n = 29), placebo plus exercise (n = 28), or placebo plus attention control (n = 27) for 6 months. The originally planned sample size was 240 participants. Due to slower than anticipated enrollment, the primary comparison was changed to the 2 combined telmisartan groups vs the 2 combined placebo groups and the target sample size was changed to 112 participants. Main Outcomes and Measures: The primary outcome was the 6-month change in 6-minute walk distance (minimum clinically important difference, 8-20 m). The secondary outcomes were maximal treadmill walking distance; Walking Impairment Questionnaire scores for distance, speed, and stair climbing; and the 36-Item Short-Form Health Survey physical functioning score. The results were adjusted for study site, baseline 6-minute walk distance, randomization to exercise vs attention control, sex, and history of heart failure at baseline. Results: Of the 114 randomized patients (mean age, 67.3 [SD, 9.9] years; 46 were women [40.4%]; and 81 were Black individuals [71.1%]), 105 (92%) completed 6-month follow-up. At 6-month follow-up, telmisartan did not significantly improve 6-minute walk distance (from a mean of 341.6 m to 343.0 m; within-group change: 1.32 m) compared with placebo (from a mean of 352.3 m to 364.8 m; within-group change: 12.5 m) and the adjusted between-group difference was-16.8 m (95% CI,-35.9 m to 2.2 m; P =.08). Compared with placebo, telmisartan did not significantly improve any of the 5 secondary outcomes. The most common serious adverse event was hospitalization for PAD (ie, lower extremity revascularization, amputation, or gangrene). Three participants (5.1%) in the telmisartan group and 2 participants (3.6%) in the placebo group were hospitalized for PAD. Conclusions and Relevance: Among patients with PAD, telmisartan did not improve 6-minute walk distance at 6-month follow-up compared with placebo. These results do not support telmisartan for improving walking performance in patients with PAD. Trial Registration: ClinicalTrials.gov Identifier: NCT02593110.

Original languageEnglish
Pages (from-to)1315-1325
Number of pages11
JournalJAMA - Journal of the American Medical Association
Issue number13
StatePublished - Oct 4 2022

Bibliographical note

Funding Information:
reported receiving grants from the National Heart, Lung, and Blood Institute, Helixmith, and Regeneron; receiving consulting fees from Cambrian Biopharma; and receiving other support from ArtAssist, HelixMith, Mars Company, ReserveAge, and Chromadex for study interventions or measures not related to the current study. No other disclosures were reported.

Funding Information:
Funding/Support: Funded by grant R01-HL126117 from the National Heart, Lung, and Blood Institute. Supported by the National Institute on Aging (intramural division) and by the Jesse Brown VA Medical Center.

Publisher Copyright:
© 2022 American Medical Association. All rights reserved.

ASJC Scopus subject areas

  • Medicine (all)


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