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ONTARGET: ARB as effective as ACE inhibitor, no need for combination

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CHICAGO — Telmisartan has fewer side effects than ramipril in patients with vascular disease or diabetes, but the efficacy of the two are similar, according to data from the ONTARGET trial presented today.

Salim Yusuf, MD, director of the Population Health Research Institute at McMaster University in Ontario, presented the results from ONTARGET. The trial aimed to determine the efficacy of ramipril, telmisartan or the two in combination in patients over 55 years old with vascular disease or diabetes. Patients were randomly assigned 10 mg of ramipril per day (n=8,576), 80 mg of telmisartan per day (n=8,542) or both (n=8,502).

In both the telmisartan and combination cohorts, mean blood pressure was lower than in the ramipril group (reduction with telmisartan, 0.9 mm Hg/0.6 mm Hg; reduction with combination, 2.4 mm Hg/1.4 mm Hg). The primary outcome (death from cardiovascular causes, MI, stroke, or hospitalization for heart failure) occurred in 1,412 patients in the ramipril cohort (16.5%), compared with 1,423 in the telmisartan cohort (16.7%; relative risk, 1.01; 95% CI, 0.94-1.09) and 1,386 in the combination cohort (16.3%; RR, 0.99; 95% CI, 0.92-1.07) after a median follow up of 56 months, according to Yusuf.

Cough and angioedema rates were lower in the telmisartan group compared with the ramipril group [cough, 1.1% vs. 4.2% (P<0.001); angioedema, 0.1% vs. 0.3% (P=0.01)], although hypotensive symptoms were higher (2.6% vs. 1.7%, P<0.001). Overall, the combination of ramipril and telmisartan resulted in additional adverse events and fewer benefits in patients with vascular disease or diabetes.

Results of ONTARGET were also published today in an online-first edition of the New England Journal of Medicine. – by Stacey L. Adams

For more information:

• Yusuf S, Teo KK, Anderson C, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. ACC 57th Annual Scientific Session; March 29-April 1, 2008. Chicago.
• N Engl J Med. doi:10.1056/NEJMoa0801317.