Key result
Telmisartan was non-inferior to ramipril in reducing fatal and nonfatal cardiovascular events, while their combination increased adverse effects without added benefit.
Why the study?
Does telmisartan alone or in combination with ramipril reduce fatal and nonfatal cardiovascular events compared to ramipril in patients with vascular disease or high-risk diabetes?
Does telmisartan alone or in combination with ramipril reduce fatal and nonfatal cardiovascular events compared to ramipril in patients with vascular disease or high-risk diabetes?
Telmisartan is a non-inferior alternative to ramipril for cardiovascular risk reduction in high-risk patients, but combining the two provides no additional benefit and increases adverse effects.
Answers are grounded in this paper and cite their sources.
Telmisartan may serve as ramipril alternative in high-risk patients; leaves open optimal single-agent strategies for cardiovascular prevention.
The recently published Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) in patients with vascular disease or high-risk diabetes, as the largest published comparative trial of these agent classes, provides further evidence concerning the comparison between the angiotensin-receptor blockers (ARBs) and the angiotensin-converting enzyme inhibitors (ACEIs). In this trial, telmisartan (an ARB) was non-inferior to ramipril (an ACEI) in reducing fatal and nonfatal cardiovascular events. Moreover, ONTARGET is an example of a high-quality noninferiority trial. However, the combination of the 2 agents was associated with more adverse effects without an increase in benefit. The study differed from several other comparative studies in which the dose and choice of ACEI was left to individual physicians. Further, in ONTARGET, the ACEI was not titrated to the maximum dose and patients with heart failure were excluded.
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Liebson et al. (2009) conducted a review in Vascular disease or high-risk diabetes. Telmisartan alone and in combination with ramipril vs. Ramipril alone was evaluated on Fatal and nonfatal cardiovascular events. Telmisartan was non-inferior to ramipril in reducing fatal and nonfatal cardiovascular events, while their combination increased adverse effects without added benefit.
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