Key result
Dual blockade of the RAAS with telmisartan and ramipril in the ONTARGET trial requires further analysis regarding blood pressure targets, renal effects, and the role of statins in patient outcomes.
This commentary emphasizes the importance of statin therapy and raises concerns about dual RAAS blockade based on the ONTARGET trial results.
Dual RAAS blockade merits clinical caution; leaves open questions on BP targets, renal effects, and statins.
Some aspects of the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study are briefly commented on in this article. The three main topics of interest related to the study that require further analysis are the following: the influence of blood pressure control, and in particular, the target blood pressure for patients with established cardiovascular disease such as those admitted in the ONTARGET study, the renal aspects of the study, which are of great interest but do not adequately clarify, in particular, concerns over the dual blockade of the renin-angiotensin-aldosterone system (RAAS) with telmisartan and ramipril, and finally, and probably most importantly, the role of statins in the outcome of the study. A high percentage of patients receiving this type of therapy at the end of the study, which probably contributed to obtaining a residual risk similar to that in the Heart Outcomes Prevention Evaluation (HOPE) study in the absence of treatment with RAAS blockers in approximately two-thirds of patients included in the ONTARGET trial.
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Ruilope et al. (2011) conducted a review in established cardiovascular disease. Telmisartan and ramipril was evaluated. Dual blockade of the RAAS with telmisartan and ramipril in the ONTARGET trial requires further analysis regarding blood pressure targets, renal effects, and the role of statins in patient outcomes.
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