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From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis.
Am J Cardiol 2002; 89(2A):18A-25A; discussion 25A-26AAJ

Abstract

The Heart Outcomes Prevention Evaluation (HOPE) study conclusively demonstrated that ramipril, an angiotensin-converting enzyme (ACE) inhibitor, reduces the risk of cardiovascular death, myocardial infarction (MI), and death in patients at risk for cardiovascular events but without heart failure. The Study to Evaluate Carotid Ultrasound Changes in Patients Treated with Ramipril and Vitamin E (SECURE) substudy demonstrated that ramipril also reduced atherosclerosis. These results suggest that the renin-angiotensin system (RAS) has a more important role in the development and progression of atherosclerosis than previously believed, and they indicate the need for further clinical studies to define the range of benefits available from modifying the RAS. Achieving maximum benefit may require treatment with both an ACE inhibitor and an angiotensin II type-1 receptor blocker (ARB). The Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) study indicated that combining an ACE inhibitor with an ARB decreased blood pressure and improved the ejection fraction more than treatment with either drug alone in patients with congestive heart failure. The Valsartan in Heart Failure Trial (Val-HeFT) showed that the combination of an ACE inhibitor and an ARB reduced hospitalization for heart failure in patients with congestive heart failure by 27.5%, although no decrease in all-cause mortality was observed. The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) is a large, long-term study (23,400 patients, 5.5 years). It will compare the benefits of ACE inhibitor treatment, ARB treatment, and treatment with an ACE inhibitor and ARB together, in a study population with established coronary artery disease, stroke, peripheral vascular disease, or diabetes with end-organ damage. Patients with congestive heart failure will be excluded. In a parallel study, patients unable to tolerate an ACE inhibitor will be randomized to receive telmisartan or placebo (the Telmisartan Randomized Assessment Study in ACE-I Intolerant Patients with Cardiovascular Disease [TRANSCEND]). The primary endpoint for both trials is a composite of cardiovascular death, MI, stroke, and hospitalization for heart failure. Secondary endpoints will investigate reductions in the development of diabetes mellitus, nephropathy, dementia, and atrial fibrillation. These 2 trials are expected to provide new insights into the optimal treatment of patients at high risk of complications from atherosclerosis.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. yusufs@mcmaster.ca

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

11835907

Citation

Yusuf, Salim. "From the HOPE to the ONTARGET and the TRANSCEND Studies: Challenges in Improving Prognosis." The American Journal of Cardiology, vol. 89, no. 2A, 2002, 18A-25A; discussion 25A-26A.
Yusuf S. From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis. Am J Cardiol. 2002;89(2A):18A-25A; discussion 25A-26A.
Yusuf, S. (2002). From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis. The American Journal of Cardiology, 89(2A), 18A-25A; discussion 25A-26A.
Yusuf S. From the HOPE to the ONTARGET and the TRANSCEND Studies: Challenges in Improving Prognosis. Am J Cardiol. 2002 Jan 24;89(2A):18A-25A; discussion 25A-26A. PubMed PMID: 11835907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis. A1 - Yusuf,Salim, PY - 2002/2/12/pubmed PY - 2002/2/23/medline PY - 2002/2/12/entrez SP - 18A-25A; discussion 25A-26A JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 89 IS - 2A N2 - The Heart Outcomes Prevention Evaluation (HOPE) study conclusively demonstrated that ramipril, an angiotensin-converting enzyme (ACE) inhibitor, reduces the risk of cardiovascular death, myocardial infarction (MI), and death in patients at risk for cardiovascular events but without heart failure. The Study to Evaluate Carotid Ultrasound Changes in Patients Treated with Ramipril and Vitamin E (SECURE) substudy demonstrated that ramipril also reduced atherosclerosis. These results suggest that the renin-angiotensin system (RAS) has a more important role in the development and progression of atherosclerosis than previously believed, and they indicate the need for further clinical studies to define the range of benefits available from modifying the RAS. Achieving maximum benefit may require treatment with both an ACE inhibitor and an angiotensin II type-1 receptor blocker (ARB). The Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) study indicated that combining an ACE inhibitor with an ARB decreased blood pressure and improved the ejection fraction more than treatment with either drug alone in patients with congestive heart failure. The Valsartan in Heart Failure Trial (Val-HeFT) showed that the combination of an ACE inhibitor and an ARB reduced hospitalization for heart failure in patients with congestive heart failure by 27.5%, although no decrease in all-cause mortality was observed. The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) is a large, long-term study (23,400 patients, 5.5 years). It will compare the benefits of ACE inhibitor treatment, ARB treatment, and treatment with an ACE inhibitor and ARB together, in a study population with established coronary artery disease, stroke, peripheral vascular disease, or diabetes with end-organ damage. Patients with congestive heart failure will be excluded. In a parallel study, patients unable to tolerate an ACE inhibitor will be randomized to receive telmisartan or placebo (the Telmisartan Randomized Assessment Study in ACE-I Intolerant Patients with Cardiovascular Disease [TRANSCEND]). The primary endpoint for both trials is a composite of cardiovascular death, MI, stroke, and hospitalization for heart failure. Secondary endpoints will investigate reductions in the development of diabetes mellitus, nephropathy, dementia, and atrial fibrillation. These 2 trials are expected to provide new insights into the optimal treatment of patients at high risk of complications from atherosclerosis. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/11835907/From_the_HOPE_to_the_ONTARGET_and_the_TRANSCEND_studies:_challenges_in_improving_prognosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002914901023232 DB - PRIME DP - Unbound Medicine ER -