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Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET): implications for reduced

Philip R Liebson1, Ezra A Amsterdam

  • 1Section of Cardiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA. pliebson@rush.edu

Preventive Cardiology
|March 24, 2009
PubMed

Insights

The Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) found that telmisartan (an angiotensin-receptor blocker) was as effective as ramipril (an angiotensin-converting enzyme inhibitor) in preventing cardiovascular events. Combining these drugs increased adverse effects without additional benefit.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • The Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) is a significant study comparing angiotensin-receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs).
  • Previous research has established the efficacy of both ARBs and ACEIs in managing cardiovascular conditions.

Purpose of the Study:

  • To compare the efficacy and safety of telmisartan (an ARB) versus ramipril (an ACEI) in patients with vascular disease or high-risk diabetes.
  • To evaluate the benefits and risks of combining telmisartan and ramipril.

Main Methods:

  • A large-scale, high-quality noninferiority trial involving patients with vascular disease or high-risk diabetes.
  • Participants were randomized to receive telmisartan, ramipril, or the combination therapy.
  • Exclusion criteria included patients with heart failure.

Main Results:

  • Telmisartan was found to be non-inferior to ramipril in reducing fatal and nonfatal cardiovascular events.
  • The combination of telmisartan and ramipril resulted in more adverse effects without a significant increase in cardiovascular benefit.
  • The study design differed from others by not always titrating ACEIs to maximum doses and excluding heart failure patients.

Conclusions:

  • Telmisartan is a viable alternative to ACEIs like ramipril for reducing cardiovascular events in high-risk populations.
  • Combining ARBs and ACEIs is not recommended due to increased adverse effects and lack of added benefit.
  • ONTARGET provides robust evidence for ARB and ACEI comparative effectiveness and combination therapy risks.

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