ONTARGET trial - Summary & Results with Ramipril Global Endpoint

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A study to test whether an ARB (which blocks the effects of angiotensin II without enhancing bradykinin) was similarly effective to an ACE inhibitor and whether the combination of an ACE inhibitor and an ARB may be superior

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ONTARGET trial - Summary & Results with Ramipril Global Endpoint

  1. 1. ONTARGET (Ongoing Telmisartan Aloneand in Combination with Ramipril GlobalEndpoint Trial)
  2. 2. ONTARGET (Ongoing Telmisartan Alone and inCombination with Ramipril Global Endpoint Trial)S Yusuf (McMaster University, Hamilton, ON)American College of Cardiology 2008 Scientific Sessions• Goal: To test whether an ARB (which blocks the effects of angiotensin II without enhancing bradykinin) was similarly effective to an ACE inhibitor and whether the combination of an ACE inhibitor and an ARB may be superior• Population and treatment: 25 620 patients ≥ 55 years of age with CHD or diabetes plus additional risk factors without evidence of HF Randomized to ramipril 10 mg/day, telmisartan 80 mg/day, or combination of the two for a mean duration of 55 months• Primary outcome: A composite of CV death, MI, stroke, or hospitalization for HFARB=angiotensin=receptor blocker
  3. 3. ONTARGET: Results• Telmisartan was shown to be noninferior to ramiprilKey resultsOutcome Ramipril Telmisartan Combination Risk ratio (95% CI)a Risk ratio (95% CI)b (n=8576), % (n=8542), % (n=8502), %Primary end point 16.5 16.7 16.3 1.01 (0.94–1.09) 0.99 (0.92–1.07)CV death/MI/stroke 14.1 13.9 14.1 0.99 (0.91–1.07) 1.00 (0.93–1.09)MI 4.8 5.2 5.2 1.07 (0.94–1.22) 1.08 (0.94–1.23)Stroke 4.7 4.3 4.4 0.91 (0.79–1.05) 0.93 (0.81–1.07)CHF hospitalization 4.1 4.6 3.9 1.12 (0.97-1.29) 0.95 (0.82– 1.10)CV death 7.0 7.0 7.3 1.00 (0.89–1.12) 1.04 (0.93–1.17)Any death 11.8 11.6 12.5 0.98 (0.90–1.07) 1.07 (0.98–1.16)Renal impairment 10.2 10.6 13.5 1.04 (0.96–1.14) 1.33 (1.22–1.44) a. Telmisartan vs ramipril b. Combination therapy vs ramipril
  4. 4. ONTARGET: Commentary*"This was a great trial. It was large, with a simple design and a rigorousnoninferiority margin, so we can definitely say that telmisartan is similarly aseffective as ramipril. It asked two specific questions and got two clear answers." - Dr Sanjay Kaul"It lays all the ghosts to rest about suggestions of increased risk of MI with ARBs—this trial shows that was all nonsense." - Dr Peter Sleight *All comments from ONTARGET: Clear messages from well-conducted study (http://www.theheart.org/article/853429.do)
  5. 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.

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