Main results and clinical interpretations from the TRANSCEND study

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Angiotensin-converting enzyme (ACE) inhibitors are widely used for cardiovascular disease prevention but cause side effects like cough and angioedema.
• Angiotensin receptor blockers (ARBs) offer an alternative for patients intolerant to ACE inhibitors, treating conditions like hypertension and heart failure.

Purpose of the Study:

• To evaluate the efficacy of telmisartan, a long-acting ARB, in reducing cardiovascular events in patients intolerant to ACE inhibitors.
• To assess telmisartan's impact on a composite endpoint including cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization.

Main Methods:

• The Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) randomized 5,926 patients intolerant to ACE inhibitors.
• Patients received either telmisartan or placebo, added to their existing treatments, for cardiovascular risk assessment.

Main Results:

• The primary composite endpoint showed a nonsignificant reduction (8%) in the telmisartan group versus placebo (15.7% vs. 17%).
• A key secondary endpoint, excluding heart failure hospitalization, was significantly reduced by 13% in the telmisartan group (13% vs. 14.8%; P = 0.046).

Conclusions:

• Telmisartan effectively reduces major cardiovascular events in high-risk patients intolerant to ACE inhibitors, excluding heart failure hospitalizations.
• Telmisartan can be considered a first-line treatment option for patients unable to tolerate ACE inhibitors due to adverse effects.