Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events
Telmisartan and ramipril are as effective in patients with vascular disease or high risk diabetes in preventing a composite outcome of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. A combination of these drugs is not more effective than ramipril alone, and causes more adverse effects. Level of evidence: "A"An RCT 1 including 25 620 compared rampiril 10 mg/day, telmisartan 80 mg/day, and both drugs. A composite outcome of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure was reached in 16.5% in the ramipril group, 16.7% in the telmisartan grop, and 16.3% in the combination therapy group. As compared with the ramipril group, the telmisartan group had lower rates of cough, angioedema, and a higher rate of hypotensive symptoms. In the combination therapy group, there was an increased risk of hypotensive symptoms, syncope, and renal dysfunction.
References
- ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008 Apr 10;358(15):1547-59. [PubMed]