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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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Related in: MedlinePlus

Comparison of telmisartan and ramipril for the relative risk of the primary renal outcomes of dialysis, doubling of serum creatinine, and death in subgroups of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) patients.Reprinted from The Lancet, with permission from Elsevier. Mann JF, Schmieder RE, McQueen MJ, et al; TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372:547–553.23Abbreviation: eGFR, estimated glomerular filtration rate.
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f2-vhrm-7-315: Comparison of telmisartan and ramipril for the relative risk of the primary renal outcomes of dialysis, doubling of serum creatinine, and death in subgroups of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) patients.Reprinted from The Lancet, with permission from Elsevier. Mann JF, Schmieder RE, McQueen MJ, et al; TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372:547–553.23Abbreviation: eGFR, estimated glomerular filtration rate.

Mentions: Analysis of renal outcomes in ONTARGET showed equivalence between telmisartan and ramipril for effects on kidney function, including the primary renal outcomes of dialysis, doubling of serum creatinine, and death (Figure 2).23 ONTARGET demonstrated that combination treatment with telmisartan and ramipril reduced albuminuria compared with ramipril (HR 0.88; P = 0.003) but was associated with increased risk of renal impairment and acute dialysis in high-risk patients with diabetes and vascular diseases.23 Compared with ramipril alone, the combination of telmisartan and ramipril resulted in a higher incidence of renal dysfunction, doubling of serum creatinine, need for dialysis, and incidence of hyperkalemia.17,23


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 renal outcomes of dialysis, doubling of serum creatinine, and death in subgroups of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) patients.Reprinted from The Lancet, with permission from Elsevier. Mann JF, Schmieder RE, McQueen MJ, et al; TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372:547–553.23Abbreviation: eGFR, estimated glomerular filtration rate.
© Copyright Policy
Related In: Results  -  Collection

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

f2-vhrm-7-315: Comparison of telmisartan and ramipril for the relative risk of the primary renal outcomes of dialysis, doubling of serum creatinine, and death in subgroups of ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) patients.Reprinted from The Lancet, with permission from Elsevier. Mann JF, Schmieder RE, McQueen MJ, et al; TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372:547–553.23Abbreviation: eGFR, estimated glomerular filtration rate.
Mentions: Analysis of renal outcomes in ONTARGET showed equivalence between telmisartan and ramipril for effects on kidney function, including the primary renal outcomes of dialysis, doubling of serum creatinine, and death (Figure 2).23 ONTARGET demonstrated that combination treatment with telmisartan and ramipril reduced albuminuria compared with ramipril (HR 0.88; P = 0.003) but was associated with increased risk of renal impairment and acute dialysis in high-risk patients with diabetes and vascular diseases.23 Compared with ramipril alone, the combination of telmisartan and ramipril resulted in a higher incidence of renal dysfunction, doubling of serum creatinine, need for dialysis, and incidence of hyperkalemia.17,23

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