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ACC: Telmisartan, Ramipril Comparable for Vascular Events

Angiotensin receptor blocker telmisartan and angiotensin-converting enzyme inhibitor ramipril have similar mortality benefit

MONDAY, March 31 (HealthDay News) -- A randomized trial comparing ramipril to telmisartan in high-risk patients concluded that the two are equivalent in reducing vascular events and death from cardiovascular causes, according to research published online March 31 in the New England Journal of Medicine and presented at the American College of Cardiology's 57th Scientific Session held this week in Chicago.

Salim Yusuf, of McMaster University in Hamilton, Ontario, Canada, and colleagues compared outcomes after treatment with angiotensin receptor blocker (ARB) telmisartan or the angiotensin-converting enzyme (ACE) inhibitor ramipril in a group of 25,620 patients with coronary, peripheral or cerebrovascular disease or diabetes with end-organ damage. After a three-week run-in phase, patients were randomized to receive 80 mg of telmisartan per day, 10 mg of ramipril per day, or both drugs.

Mean blood pressure was 2.4/1.4 mm Hg lower in the combination therapy group, and 0.9/0.6 mm Hg in the telmisartan group, compared to the ramipril group, the investigators found. No significant difference in rates of death from cardiovascular cause, myocardial infarction, stroke or hospitalization for heart failure between the three groups was seen. However, the incidence of cough and angioedema was lower in the telmisartan group. Combination therapy was associated with an increased risk of hypotensive symptoms, syncope and renal dysfunction.

"Because ARBs are more costly than ACE inhibitors and are not better tolerated overall, their primary value is as an alternative for patients who cannot tolerate ACE inhibitors because of cough," writes the author of an accompanying editorial.

This research was partially funded by Boehringer Ingelheim, and the authors report financial links to Boehringer Ingelheim and other pharmaceutical companies.

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