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Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease.

Abstract

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers reduce left ventricular hypertrophy (LVH). The effect of these drugs on LVH in high-risk patients without heart failure is unknown.

METHODS AND RESULTS

In the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET), patients at high vascular risk and tolerant of ACE inhibitors were randomly assigned to ramipril, telmisartan, or their combination (n=23 165). In the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND), patients intolerant of ACE inhibitors were randomized to telmisartan or placebo (n=5343). Prevalence of LVH at entry in TRANSCEND was 12.7%. It was reduced by telmisartan (10.5% and 9.9% after 2 and 5 years) compared with placebo (12.7% and 12.8% after 2 and 5 years) (overall odds ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.0017). New-onset LVH occurred less frequently with telmisartan compared with placebo (overall odds ratio, 0.63; 95% CI, 0.51 to 0.79; P=0.0001). LVH regression was similar in the 2 groups. In ONTARGET, prevalence of LVH at entry was 12.4%. At follow-up, it occurred slightly less frequently with telmisartan (odds ratio, 0.92; 95% CI, 0.83 to 1.01; P=0.07) and the combination (odds ratio, 0.93; 95% CI, 0.84 to 1.02; P=0.12) than with ramipril, but differences between the groups were not significant. New-onset LVH was associated with a higher risk of primary outcome during follow-up (hazard ratio, 1.77; 95% CI, 1.50 to 2.07).

CONCLUSIONS

In patients at high vascular risk, telmisartan is more effective than placebo in reducing LVH. New-onset LVH is reduced by 37%. The effect of combination of the 2 drugs on LVH is similar to that of ramipril alone.

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  • Authors+Show Affiliations

    ,

    McMaster University, Population Health Research Institute, 237 Barton St E, Hamilton, ON L8L2X2 Canada. verdec@tin.it

    , , , , , , , , , , , , , ,

    Source

    Circulation 120:14 2009 Oct 06 pg 1380-9

    MeSH

    Aged
    Angiotensin-Converting Enzyme Inhibitors
    Antihypertensive Agents
    Benzimidazoles
    Benzoates
    Cardiovascular Diseases
    Diastole
    Double-Blind Method
    Drug Therapy, Combination
    Drug Tolerance
    Electrocardiography
    Female
    Humans
    Hypertrophy, Left Ventricular
    Male
    Odds Ratio
    Placebos
    Prevalence
    Proportional Hazards Models
    Ramipril
    Regression Analysis
    Systole
    Telmisartan

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19770395

    Citation

    Verdecchia, Paolo, et al. "Effects of Telmisartan, Ramipril, and Their Combination On Left Ventricular Hypertrophy in Individuals at High Vascular Risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease." Circulation, vol. 120, no. 14, 2009, pp. 1380-9.
    Verdecchia P, Sleight P, Mancia G, et al. Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease. Circulation. 2009;120(14):1380-9.
    Verdecchia, P., Sleight, P., Mancia, G., Fagard, R., Trimarco, B., Schmieder, R. E., ... Yusuf, S. (2009). Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease. Circulation, 120(14), pp. 1380-9. doi:10.1161/CIRCULATIONAHA.109.865774.
    Verdecchia P, et al. Effects of Telmisartan, Ramipril, and Their Combination On Left Ventricular Hypertrophy in Individuals at High Vascular Risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease. Circulation. 2009 Oct 6;120(14):1380-9. PubMed PMID: 19770395.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease. AU - Verdecchia,Paolo, AU - Sleight,Peter, AU - Mancia,Giuseppe, AU - Fagard,Robert, AU - Trimarco,Bruno, AU - Schmieder,Roland E, AU - Kim,Jae-Hyung, AU - Jennings,Garry, AU - Jansky,Petr, AU - Chen,Jyh-Hong, AU - Liu,Lisheng, AU - Gao,Peggy, AU - Probstfield,Jeffrey, AU - Teo,Koon, AU - Yusuf,Salim, AU - ,, Y1 - 2009/09/21/ PY - 2009/9/23/entrez PY - 2009/9/23/pubmed PY - 2009/10/24/medline SP - 1380 EP - 9 JF - Circulation JO - Circulation VL - 120 IS - 14 N2 - BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers reduce left ventricular hypertrophy (LVH). The effect of these drugs on LVH in high-risk patients without heart failure is unknown. METHODS AND RESULTS: In the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET), patients at high vascular risk and tolerant of ACE inhibitors were randomly assigned to ramipril, telmisartan, or their combination (n=23 165). In the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND), patients intolerant of ACE inhibitors were randomized to telmisartan or placebo (n=5343). Prevalence of LVH at entry in TRANSCEND was 12.7%. It was reduced by telmisartan (10.5% and 9.9% after 2 and 5 years) compared with placebo (12.7% and 12.8% after 2 and 5 years) (overall odds ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.0017). New-onset LVH occurred less frequently with telmisartan compared with placebo (overall odds ratio, 0.63; 95% CI, 0.51 to 0.79; P=0.0001). LVH regression was similar in the 2 groups. In ONTARGET, prevalence of LVH at entry was 12.4%. At follow-up, it occurred slightly less frequently with telmisartan (odds ratio, 0.92; 95% CI, 0.83 to 1.01; P=0.07) and the combination (odds ratio, 0.93; 95% CI, 0.84 to 1.02; P=0.12) than with ramipril, but differences between the groups were not significant. New-onset LVH was associated with a higher risk of primary outcome during follow-up (hazard ratio, 1.77; 95% CI, 1.50 to 2.07). CONCLUSIONS: In patients at high vascular risk, telmisartan is more effective than placebo in reducing LVH. New-onset LVH is reduced by 37%. The effect of combination of the 2 drugs on LVH is similar to that of ramipril alone. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/19770395/Effects_of_telmisartan_ramipril_and_their_combination_on_left_ventricular_hypertrophy_in_individuals_at_high_vascular_risk_in_the_Ongoing_Telmisartan_Alone_and_in_Combination_With_Ramipril_Global_End_Point_Trial_and_the_Telmisartan_Randomized_Assessment_Study_in_ACE_Intolerant_Subjects_With_Cardiovascular_Disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.109.865774?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -