Key result
Telmisartan matches ramipril for CV and renal protection, while combination therapy offers no additional benefit.
Why the study?
Progressive renal function decline in CKD is linked to increased cardiovascular risk, and the renoprotective effects of ACE inhibitors and ARBs need clarification.
Do ACE inhibitors and ARBs provide cardiovascular and renal protection in patients with chronic kidney disease?
Do ACE inhibitors and ARBs provide cardiovascular and renal protection in patients with chronic kidney disease?
ACE inhibitors and ARBs provide renoprotection and cardiovascular risk reduction in CKD patients, with telmisartan showing similar efficacy to ramipril but better tolerability, and no added benefit from combination therapy.
Progressive decline of renal function in chronic kidney disease (CKD), measured by a reduced glomerular filtration rate or albuminuria, is linked to an increased risk of cardiovascular (CV) disease. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), most likely because of their blockade of the pathophysiological effects of angiotensin II, provide renoprotection and are the treatment of choice in patients with CKD including those with diabetes. This renoprotective property appears to be partly independent of the blood pressure-lowering effect of drugs that intervene in the renin–angiotensin–aldosterone system. Recent data from the ONTARGET study show that the ARB telmisartan has similar CV and renal protection as the ACE-inhibitor ramipril in patients at risk but is better tolerated. Although extensively used by nephrologists, no additional benefit was observed with the combination of telmisartan plus ramipril compared with ramipril alone on the composite renal endpoint.
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Dobre et al. (2009) conducted a review in Chronic kidney disease (CKD) and cardiovascular risk. Telmisartan or telmisartan plus ramipril vs. Ramipril alone was evaluated on Composite renal endpoint and cardiovascular protection. Telmisartan provided similar cardiovascular and renal protection as ramipril, while the combination of telmisartan and ramipril offered no additional benefit on the composite renal endpoint.
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