Key result
Telmisartan matches ramipril for reducing major cardiovascular events in high-risk patients.
Why the study?
RAAS blockade is a key cardioprotective intervention, and telmisartan is the first ARB to show promising cardiovascular risk reduction in high-risk patients.
Does telmisartan reduce cardiovascular events and provide cardioprotection in high-risk patients?
Does telmisartan reduce cardiovascular events and provide cardioprotection in high-risk patients?
Relative Risk: 1.01 (95% CI 0.94–1.09)
Absolute Event Rate: 16.7% vs 16.5%
Telmisartan is an effective and well-tolerated angiotensin receptor blocker that provides significant cardioprotection and 24-hour blood pressure control in high-risk cardiovascular patients.
May support telmisartan as ramipril alternative in ACEI-intolerant patients; confirms trial equivalence but leaves broader applicability open.
Cardiovascular risk reduction has been the target of several large clinical trials in the last decade. As the activation of the renin-angiotensin-aldosterone system (RAAS) plays a central role in the pathogenesis of atherosclerosis and cardiovascular disease, RAAS blockade has been suggested to be among the most efficient cardioprotective interventions, as revealed with the angiotensin converting enzyme (ACE) inhibitors trials. The angiotensin receptor blockers' (ARBs) efficacy in lowering blood pressure has been very well established. Telmisartan is however the first ARB to show a promising role in reducing cardiovascular risk in high-risk patients. This article will highlight the role of telmisartan in cardioprotection, underlying specifically the results of two major randomized controlled trials: ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized AssessmeNt Study in aCE-iNtolerant subjects with cardiovascular Disease).
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A 2011 study conducted a review in Vascular disease or high-risk diabetes (n=25,620). Telmisartan vs. Ramipril 10 mg/day was evaluated on Composite of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure (RR 1.01, 95% CI 0.94-1.09). Telmisartan was equivalent to ramipril in reducing the primary composite outcome of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure in high-risk patients (RR 1.01).
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