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Reappraisal of role of angiotensin receptor blockers in cardiovascular protection.

Ram CV - Vasc Health Risk Manag (2011)

Bottom Line: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown cardioprotective and renoprotective properties.These agents are recommended as first-line therapy for the treatment of hypertension and the reduction of cardiovascular risk.Early studies pointed to the cardioprotective and renoprotective effects of ARBs in high-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Institute of Dallas Nephrology Associates, and Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA. ramv@dneph.com

ABSTRACT
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown cardioprotective and renoprotective properties. These agents are recommended as first-line therapy for the treatment of hypertension and the reduction of cardiovascular risk. Early studies pointed to the cardioprotective and renoprotective effects of ARBs in high-risk patients. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) established the clinical equivalence of the cardioprotective and renoprotective effects of telmisartan and ramipril, but did not find an added benefit of the combination over ramipril alone. Similar findings were observed in the Telmisartan Randomized AssessmeNt Study in aCE INtolerant subjects with cardiovascular Disease (TRANSCEND) trial conducted in ACEI-intolerant patients. In ONTARGET, telmisartan had a better tolerability profile with similar renoprotective properties compared with ramipril, suggesting a potential clinical benefit over ramipril. The recently completed Olmesartan Reducing Incidence of Endstage Renal Disease in Diabetic Nephropathy Trial (ORIENT) and Olmesartan and Calcium Antagonists Randomized (OSCAR) studies will further define the role of ARBs in cardioprotection and renoprotection for high-risk patients.

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Comparison of telmisartan and ramipril for the relative risk of the primary and secondary outcomes of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. The main secondary outcome was death from cardiovascular causes, myocardial infarction, or stroke. The P value is for the comparison with the noninferiority margins.Copyright © 2008. Reproduced with permission from ONTARGET Investigators; Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.17
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f1-vhrm-7-315: Comparison of telmisartan and ramipril for the relative risk of the primary and secondary outcomes of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. The main secondary outcome was death from cardiovascular causes, myocardial infarction, or stroke. The P value is for the comparison with the noninferiority margins.Copyright © 2008. Reproduced with permission from ONTARGET Investigators; Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.17

Mentions: ONTARGET resolved the question regarding the effectiveness of an ARB compared with an ACEI in high-risk patients with cardiovascular disease or diabetes mellitus without heart failure,17 although there continues to be confusion over the clinical implications of these findings. In ONTARGET, telmisartan was shown to be equivalent to ramipril in the incidence of primary outcome of death from cardiovascular causes, myocardial infarction, stroke, and hospitalization for heart failure (Figure 1).17 To underscore their similarities, the primary outcome occurred in 16.5%, 16.7%, and 16.3% of patients receiving ramipril alone, telmisartan alone, or their combination, respectively. The secondary outcome in ONTARGET, death from cardiovascular causes, myocardial infarction, or stroke, occurred in 14.1%, 13.9%, and 14.1% of patients receiving ramipril alone, telmisartan alone, or their combination, respectively. The relative risk ratio was 1.01 for the primary outcome and 0.99 for the secondary outcome with telmisartan versus ramipril, suggesting similarities in the degree of cardioprotection offered by these agents individually and in combination over ramipril alone.17


Reappraisal of role of angiotensin receptor blockers in cardiovascular protection.

Ram CV - Vasc Health Risk Manag (2011)

Comparison of telmisartan and ramipril for the relative risk of the primary and secondary outcomes of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. The main secondary outcome was death from cardiovascular causes, myocardial infarction, or stroke. The P value is for the comparison with the noninferiority margins.Copyright © 2008. Reproduced with permission from ONTARGET Investigators; Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.17
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3104608&req=5

f1-vhrm-7-315: Comparison of telmisartan and ramipril for the relative risk of the primary and secondary outcomes of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. The main secondary outcome was death from cardiovascular causes, myocardial infarction, or stroke. The P value is for the comparison with the noninferiority margins.Copyright © 2008. Reproduced with permission from ONTARGET Investigators; Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.17
Mentions: ONTARGET resolved the question regarding the effectiveness of an ARB compared with an ACEI in high-risk patients with cardiovascular disease or diabetes mellitus without heart failure,17 although there continues to be confusion over the clinical implications of these findings. In ONTARGET, telmisartan was shown to be equivalent to ramipril in the incidence of primary outcome of death from cardiovascular causes, myocardial infarction, stroke, and hospitalization for heart failure (Figure 1).17 To underscore their similarities, the primary outcome occurred in 16.5%, 16.7%, and 16.3% of patients receiving ramipril alone, telmisartan alone, or their combination, respectively. The secondary outcome in ONTARGET, death from cardiovascular causes, myocardial infarction, or stroke, occurred in 14.1%, 13.9%, and 14.1% of patients receiving ramipril alone, telmisartan alone, or their combination, respectively. The relative risk ratio was 1.01 for the primary outcome and 0.99 for the secondary outcome with telmisartan versus ramipril, suggesting similarities in the degree of cardioprotection offered by these agents individually and in combination over ramipril alone.17

Bottom Line: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown cardioprotective and renoprotective properties.These agents are recommended as first-line therapy for the treatment of hypertension and the reduction of cardiovascular risk.Early studies pointed to the cardioprotective and renoprotective effects of ARBs in high-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Clinical Research Institute of Dallas Nephrology Associates, and Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA. ramv@dneph.com

ABSTRACT
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have shown cardioprotective and renoprotective properties. These agents are recommended as first-line therapy for the treatment of hypertension and the reduction of cardiovascular risk. Early studies pointed to the cardioprotective and renoprotective effects of ARBs in high-risk patients. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) established the clinical equivalence of the cardioprotective and renoprotective effects of telmisartan and ramipril, but did not find an added benefit of the combination over ramipril alone. Similar findings were observed in the Telmisartan Randomized AssessmeNt Study in aCE INtolerant subjects with cardiovascular Disease (TRANSCEND) trial conducted in ACEI-intolerant patients. In ONTARGET, telmisartan had a better tolerability profile with similar renoprotective properties compared with ramipril, suggesting a potential clinical benefit over ramipril. The recently completed Olmesartan Reducing Incidence of Endstage Renal Disease in Diabetic Nephropathy Trial (ORIENT) and Olmesartan and Calcium Antagonists Randomized (OSCAR) studies will further define the role of ARBs in cardioprotection and renoprotection for high-risk patients.

Show MeSH
Related in: MedlinePlus