Telmisartan effective alternative to ACE inhibitor
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Patients treated with telmisartan had lower rates of cough |
Telmisartan, an angiotensin II receptor blocker, is an effective alternative
treatment to the angiotensin-converting enzyme inhibitor ramipril in
preventing cardiovascular events and has fewer side effects, according
to data
from a study presented at the annual scientific meeting of the
American College of Cardiology in Chicago this week.
However, combining
the two drugs did not produce any additional benefits and was associated
with more adverse events.
ONTARGET — the largest clinical trial ever undertaken with an angiotensin
II receptor blocker — was designed to measure the effect of ramipril,
telmisartan, or a combination of the two, in patients aged over 55 years
with coronary heart disease or diabetes.
Investigators from 733 centres in 40 countries enrolled 25,620 patients
with coronary heart disease or diabetes plus additional risk factors,
but without evidence of heart failure, to receive 10mg ramipril per day
(n=8,576), 80mg telmisartan per day (n= 8,542) or combination therapy
(n=8,502). The composite primary end point was death from cardiovascular
causes, myocardial infarction, stroke or admission to hospital with heart
failure.
At a median follow-up of 56 months, the primary outcome had occurred
in 1,412 patients (16.5 per cent) in the ramipril arm, 1,423 patients
(16.7 per cent) in the telmisartan arm and 1,386 patients (16.3 per cent)
in the combination therapy arm.
In comparison with the ramipril group,
the telmisartan group had lower rates of cough (1.1 per cent versus 4.2
per cent; P<0.001) and angioedema (0.1 per cent versus 0.3
per cent; P=0.01), but higher rates of hypotensive symptoms
(2.6 per cent versus 1.7 per cent; P=0.001). Patients receiving
the combination treatment showed increased hypotension, syncope and renal
dysfunction.
“This study is of clinical importance because it demonstrates that
telmisartan is an effective and safe alternative to ramipril. This means
both patients
and physicians have choices and can use telmisartan where appropriate
with a high degree of confidence,” said lead investigator Salim
Yusuf, of McMaster University, Hamilton, Ontario. “Combination
therapy is not recommended.”
There was no evidence, he added, that the benefits can be extrapolated
to other angiotensin II receptor blockers.
Omar Ali, a pharmacist at Surrey and Sussex Healthcare NHS Trust, commented: “The
results endorse the current UK approach of using ACE inhibitors first
line for cardiovascular prevention, but show that you can switch with
confidence to telmisartan if patients are intolerant.”
To coincide with the meeting, the study was published
online in The New
England Journal of Medicine. |
The
Pharmaceutical Journal
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