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  • Yusuf, Salim (author)

Telmisartan, ramipril, or both in patients at high risk for vascular events.

  • Article/chapterEnglish2008

Publisher, publication year, extent ...

  • 2008

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/75602
  • https://gup.ub.gu.se/publication/75602URI
  • https://doi.org/10.1056/NEJMoa0801317DOI

Supplementary language notes

  • Language:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • BACKGROUND: In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-converting-enzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs) in such patients is unknown. We compared the ACE inhibitor ramipril, the ARB telmisartan, and the combination of the two drugs in patients with vascular disease or high-risk diabetes. METHODS: After a 3-week, single-blind run-in period, patients underwent double-blind randomization, with 8576 assigned to receive 10 mg of ramipril per day, 8542 assigned to receive 80 mg of telmisartan per day, and 8502 assigned to receive both drugs (combination therapy). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. RESULTS: Mean blood pressure was lower in both the telmisartan group (a 0.9/0.6 mm Hg greater reduction) and the combination-therapy group (a 2.4/1.4 mm Hg greater reduction) than in the ramipril group. At a median follow-up of 56 months, the primary outcome had occurred in 1412 patients in the ramipril group (16.5%), as compared with 1423 patients in the telmisartan group (16.7%; relative risk, 1.01; 95% confidence interval [CI], 0.94 to 1.09). As compared with the ramipril group, the telmisartan group had lower rates of cough (1.1% vs. 4.2%, P<0.001) and angioedema (0.1% vs. 0.3%, P=0.01) and a higher rate of hypotensive symptoms (2.6% vs. 1.7%, P<0.001); the rate of syncope was the same in the two groups (0.2%). In the combination-therapy group, the primary outcome occurred in 1386 patients (16.3%; relative risk, 0.99; 95% CI, 0.92 to 1.07); as compared with the ramipril group, there was an increased risk of hypotensive symptoms (4.8% vs. 1.7%, P<0.001), syncope (0.3% vs. 0.2%, P=0.03), and renal dysfunction (13.5% vs. 10.2%, P<0.001). CONCLUSIONS: Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit. (ClinicalTrials.gov number, NCT00153101 [ClinicalTrials.gov].).

Subject headings and genre

  • Aged
  • Angioedema
  • chemically induced
  • Angiotensin II Type 1 Receptor Blockers
  • adverse effects
  • therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors
  • adverse effects
  • therapeutic use
  • Benzimidazoles
  • adverse effects
  • therapeutic use
  • Benzoates
  • adverse effects
  • therapeutic use
  • Blood Pressure
  • drug effects
  • Cardiovascular Diseases
  • drug therapy
  • epidemiology
  • mortality
  • Creatinine
  • blood
  • Diabetes Mellitus
  • drug therapy
  • Double-Blind Method
  • Drug Therapy
  • Combination
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Kaplan-Meiers Estimate
  • Male
  • Middle Aged
  • Ramipril
  • adverse effects
  • therapeutic use
  • Risk

Added entries (persons, corporate bodies, meetings, titles ...)

  • Teo, Koon K (author)
  • Pogue, Janice (author)
  • Dyal, Leanne (author)
  • Copland, Ingrid (author)
  • Schumacher, Helmut (author)
  • Dagenais, Gilles (author)
  • Sleight, Peter (author)
  • Anderson, Craig,1976Gothenburg University,Göteborgs universitet,Institutionen för cell- och molekylärbiologi,Department of Cell and Molecular Biology(Swepub:gu)xandcr (author)
  • Dellborg, Mikael,1954Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin,Institute of Medicine, Department of Emergeny and Cardiovascular Medicine(Swepub:gu)xdelmi (author)
  • Wilhelmsen, Lars,1932Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin,Institute of Medicine, Department of Emergeny and Cardiovascular Medicine(Swepub:gu)xwilhl (author)
  • Göteborgs universitetInstitutionen för cell- och molekylärbiologi (creator_code:org_t)

Related titles

  • In:The New England journal of medicine358:15, s. 1547-591533-4406

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