Angiotensin receptor blockers in clinical practice--implications of the ONTARGET study

Hypertension and cardiovascular disease remain the major causes of premature morbidity and mortality. Following a diagnosis of hypertension, treatment with antihypertensive medication will almost invariably be lifelong. Even when prescribed treatment, many patients remain above blood pressure goals, and this is particularly common in patients at high risk of cardiovascular events due to the presence of other risk factors such as diabetes mellitus. An important cause of this failure is medication nonadherence, which is particularly common with treatments that have side-effects. Antihypertensive drugs do not make the patient feel better in the short term, but side-effects often occur immediately. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) is highly relevant to clinical practice because it demonstrated that the angiotensin receptor blocker (ARB) telmisartan is as effective as the proven angiotensinconverting enzyme inhibitor ramipril in preventing cardiovascular events in high-risk patients, while being better tolerated. Evidence of the advantages of telmisartan in the management of cardiovascular morbidity suggest, therefore, that it might be a better treatment option for hypertensive patients and that switching to generic ARBs may not always be best.