Background: Telmisartan has been known to reduce late loss in hypertensive patients with coronary artery disease requiring stent implantation. We compared the effects of telmisartan and valsartan on neointima volume and atherosclerosis progression with intravascular ultrasonography (IVUS) after zotarolimus-eluting stent (ZES) implantation in hypertensive type 2 diabetic patients. Methods: This was a prospective, randomized, single-blinded, 8 months follow-up study including hypertensive type 2 diabetic patients with significant coronary artery stenosis assigned to the telmisartan group (n=25) and the valsartan group (n=25). Neointima volume was measured by repeat IVUS examination. Atherosclerosis progression was also measured by repeat IVUS 10 mm proximal and distal to the stented segment. Results: Percent neointima volume (15.4 짹 11.6% and 21.1 짹 15.2%, p<0.05, respectively) and total neointima volume (145.7 짹 97.7 mm3 and 189.1 짹 115.7 mm3, p<0.05, respectively) were significantly lower in the telmisartan group compared with the valsartan group at 8 months. The changes from baseline in total atheroma volume 10 mm proximal to the stented segment were 11.3 짹 10.4% in the telmisartan group and 13.1 짹 13.5 mm3 in the valsartan group (p=NS), and 10 mm distal to the stented segment were 10.2 짹 11.5% in the telmisartan group and 13.5 짹 15.1 mm3 in the valsartan group (p=NS). The increase in adiponectin concentrations from baseline was significantly greater in the telmisartan group compared with the valsartan group (1.3 짹 1.4 vs. 0.2 짹 1.6 關g/ml, p<0.05, respectively). Major adverse cardiac events were similar between the 2 groups. Conclusion: Telmisartan compared with valsartan was associated with significant decrease in the total neointima volume with no significant differences in the atherosclerosis progression after ZES implantation in hypertensive type 2 diabetic patients with significant coronary narrowings.