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Results of the ONTARGET and TRANSCEND studies: an update and discussion

David Fitchett1

  • 1St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada. fitchettd@smh.toronto.on.ca

Vascular Health and Risk Management
|May 14, 2009
PubMed

Insights

Angiotensin receptor blockers (ARBs) offer vascular protection comparable to ACE inhibitors in high-risk patients. While ARBs show promise, ACE inhibitors remain the preferred choice due to extensive supporting evidence.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology

Background:

  • The renin-angiotensin-aldosterone system (RAAS) is crucial in cardiovascular disease pathophysiology.
  • Angiotensin converting enzyme inhibitors (ACEi) reduce cardiovascular events in high-risk individuals.
  • Angiotensin receptor blockers (ARBs) are effective in heart failure and non-inferior to ACEi post-myocardial infarction.

Purpose of the Study:

  • To evaluate the efficacy of ARBs for vascular protection.
  • To compare the vascular protective properties of ARBs and ACEi.

Main Methods:

  • The ONTARGET study compared the ARB telmisartan to the ACEi ramipril in high-risk patients.
  • The TRANSCEND study assessed ARB use in patients intolerant to ACEi.

Main Results:

  • Telmisartan demonstrated 95% of ramipril's vascular protective effects in ONTARGET.
  • TRANSCEND showed a trend towards benefit for cardiovascular death, MI, and stroke with ARB use, despite a neutral primary endpoint.
  • ARBs exhibited excellent tolerance in ACEi-intolerant patients.

Conclusions:

  • ARBs can be utilized for vascular protection in high-risk individuals as an alternative to ACEi.
  • ACEi are likely to remain the first-line therapy due to a larger evidence base.

Keywords:
angiotensin converting enzyme inhibitorangiotensin receptor blockervascular protection

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