Key result
Telmisartan matches ramipril in high-risk patients with better tolerability, but their combination increases adverse events.
Why the study?
Are ARBs (telmisartan) as effective and well-tolerated as ACE inhibitors (ramipril) for cardiovascular protection in high-risk patients?
Are ARBs (telmisartan) as effective and well-tolerated as ACE inhibitors (ramipril) for cardiovascular protection in high-risk patients?
Telmisartan provides equivalent cardiovascular protection to ramipril with better tolerability in high-risk patients, but combination therapy increases the risk of adverse events like renal dysfunction.
Supports telmisartan as ramipril alternative in high-risk patients; leaves open need for prospective trials before guideline changes.
Clinical trials have shown the efficacy of angiotensin II receptor blockers (ARBs) in patients with hypertension and have suggested that ARBs are noninferior to angiotensin-converting enzyme (ACE) inhibitors in patients with ischemic heart disease and heart failure. The Heart Outcomes Prevention Evaluation (HOPE), a landmark study in high cardiovascular risk management, demonstrated the cardioprotection of the ACE inhibitor ramipril. Thus, in the recent Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET®) ramipril was selected as a comparator when exploring the cardioprotective potential of telmisartan in the first head-to-head comparison of an ACE inhibitor and an ARB in a broad cross-sectional cohort of cardiovascular high-risk patients. ONTARGET showed that telmisartan is as effective as ramipril in the management of these patients but is better tolerated. The combination of ramipril and telmisartan did not confer a further benefit but did bring about an increased rate of adverse events such as renal dysfunction. In previous ARB outcome trials, cardiovascular risk profile, nature and severity of the underlying cardiovascular disease, dosing regimens and concomitant therapies, follow-up, and endpoints have varied greatly so that caution is warranted in extrapolating evidence gained from high-risk patients to other conditions such as acute myocardial infarction or chronic heart failure.
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Böhm et al. (2010) conducted a review in Cardiovascular high-risk. Telmisartan vs. Ramipril was evaluated. Telmisartan was as effective as ramipril in managing cardiovascular high-risk patients and better tolerated, while their combination increased adverse events without added benefit.
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