Key result
Combination therapy with telmisartan and ramipril for 6 months reduced left ventricular mass index by 15.6%, compared to 11.4% with telmisartan alone and 9.9% with ramipril alone.
Why the study?
Does telmisartan, ramipril, or their combination improve ventricular and vascular remodeling in treatment-naive hypertensive patients?
RCT (n=75)
Open-label
Does telmisartan, ramipril, or their combination improve ventricular and vascular remodeling in treatment-naive hypertensive patients?
Answers are grounded in this paper and cite their sources.
Combination therapy with telmisartan and ramipril provides greater regression of left ventricular hypertrophy and vascular remodeling than either agent alone in moderately to severely hypertensive patients.
Angiotensin II induces inflammatory activation of vascular smooth muscle cells and can cause left ventricular hypertrophy (LVH). Telmisartan is an angiotensin II receptor blocker with demonstrated beneficial effects on cardiac and vascular structure and function in animal models. The angiotensin-converting enzyme inhibitor ramipril also reduces ventricular and vascular remodelling. The open-label study observed 75 treatment-naive, moderately or severely hypertensive (systolic blood pressure 160-190 mmHg, diastolic blood pressure 90-110 mmHg) patients (age range, 42-58 years) treated with once-daily telmisartan 40 mg force-titrated to 80 mg after 1 month (n=25), once-daily ramipril 2.5 mg force-titrated to 5 mg after 1 month (n=25), or once-daily telmisartan 40 mg plus ramipril 2.5 mg (n=25); the total duration of treatment was 6 months. At baseline, blood pressure, left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and carotid cross-sectional intima-media area (CSA) were measured. Measurements were repeated 1, 3 and 6 months after initiation of treatment. After 6 months, comparable blood pressure reductions were achieved with the three treatments. Reductions in LVMI after 6 months' treatment were 11.4%, 9.9% and 15.6% with telmisartan, ramipril, and telmisartan plus ramipril, respectively. Respective reductions in IMT were 14.6%, 12.0% and 18.2%, and for CSA were 7.8%, 4.3% and 11.5%. In conclusion, treatment with telmisartan or ramipril for 6 months resulted in regression of LVH and vascular remodelling. When a combination of telmisartan and ramipril was administered, additional regression and remodelling occurred.
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Petrovic et al. (2005) conducted an RCT in Hypertension (n=75). Telmisartan plus ramipril vs. Telmisartan alone or ramipril alone was evaluated on Reduction in left ventricular mass index (LVMI). Combination therapy with telmisartan and ramipril for 6 months reduced left ventricular mass index by 15.6%, compared to 11.4% with telmisartan alone and 9.9% with ramipril alone.
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