The ongoing telmisartan alone and in combination with ramipril global endpoint trial program

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Trials

Background:

• The renin-angiotensin system, crucial for homeostasis, contributes to cardiovascular pathology via angiotensin II type 1 receptor activation.
• AT(1) receptor activation is implicated in atherosclerosis, oxidative stress, inflammation, and prothrombotic states.

Purpose of the Study:

• To compare the efficacy of telmisartan (angiotensin II receptor blocker), ramipril (angiotensin-converting enzyme inhibitor), and their combination in reducing cardiovascular risk.
• To evaluate cardiovascular outcomes in high-risk patients, including those intolerant to ACE inhibitors.

Main Methods:

• The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) program comprises two randomized, double-blind trials: ONTARGET and TRANSCEND.
• ONTARGET includes telmisartan, ramipril, and combination therapy; TRANSCEND compares telmisartan to placebo in ACE inhibitor-intolerant patients.
• Both trials assess cardiovascular outcomes in high-risk patients, mirroring the HOPE study criteria.

Main Results:

• Primary endpoints include cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization.
• Secondary endpoints for hypothesis generation include new-onset heart failure, revascularization, diabetes, nephropathy, cognitive decline, and atrial fibrillation.

Conclusions:

• The ONTARGET program provides critical data on the comparative efficacy of ARBs, ACE inhibitors, and combination therapy for cardiovascular risk management.
• Findings will inform treatment strategies for high-risk cardiovascular patients, including those with ACE inhibitor intolerance.