TRANSCEND (Telmisartan RandomizedAssessment Study in ACE-IntolerantSubjects With Cardiovascular Disease)
TRANSCEND (Telmisartan Randomized Assessment Studyin ACE-Intolerant Subjects With Cardiovascular Disease)KK Teo (McMaster University, Hamilton, ON)European Society of Cardiology 2008 Congress• Background: While it is well established that ACE inhibitors reduce mortality, MI, stroke, and HF in patients with CV disease or high-risk diabetes, the role of angiotensin-receptor blockers (ARBs) in primary or secondary prevention in these patients remains unclear• Population and treatment: 5926 patients with CV disease or high-risk diabetes without HF who were intolerant to ACE inhibitors Randomized to telmisartan 80 mg per day (n=2954) or placebo (n=2972) in addition to other usual therapies• Primary outcome: CV death, MI, stroke, or admission to the hospital for HF events
TRANSCEND: Results• Patients on telmisartan had, on average, a 4-mm-Hg reduction in BP compared with those on placebo• There was no difference in the incidence of the primary end point with telmisartan vs placebo: 15.7% and 17.0% (HR 0.92; p=0.216) for telmisartan and placebo, respectively• There was a difference in the prespecified composite secondary outcome of CV death, MI, and stroke: 13.0% and 14.8% (HR 0.87; p=0.048) for telmisartan and placebo, respectively—this difference became nonsignificant after statistical adjustments were made for multiple comparisons (p=0.068)
TRANSCEND: Commentary*"How [can] telmisartan . . . be noninferior to ramipril [based on ONTARGET] butbarely better than placebo? [The findings] illustrate the complexity of interpretingdifferent patient populations and trying to come up with a conclusion." - Dr Karl Swedberg"This shows that if you have good background treatment, the ARB effect is not asgood as we have seen in the earlier studies. The ACE inhibitors should be what weuse first. . . . The whole issue of ARBs or even ACE inhibitors in people whohavent got other indications such as hypertension or diabetes has to be broughtinto question." - Dr Phil Aylward *All comments from ARBs unable to TRANSCEND placebo in high-risk patients (http://www.theheart.org/article/899035.do)
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