Telmisartan could be an alternative for patients who cant tolerate ACE inhibitors

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Telmisartan, designed to lower blood pressure, reduced the incidence of cardiovascular death, heart attack or stroke in people who are unable to tolerate the standard treatment, according to the TRANSCEND trial presented at this week’s European Society of Cardiology (ESC) congress in Munich, Germany.

Salim Yusuf, MD, and Koon Teo, MD, professors in the Michael G. DeGroote School of Medicine at McMaster University and clinicians at Hamilton Health Sciences in Hamilton, Ontario, led the study that was published online Aug. 31 in the Lancet.

Telmisartan (Micardis from Boehringer-Ingelheim) is a type of angiotensin-receptor blocker (ARB), which block the receptor sites in the body for angiotensin II, a naturally occurring hormone that constricts blood vessels and increases blood pressure.

The TRANSCEND (Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease) study enrolled nearly 6,000 people worldwide who are intolerant to ACE inhibitors, and evaluated whether telmisartan, compared to placebo, would reduce the risk of major cardiovascular events. A high proportion of patients received proven therapies, such as statins, anti-platelet agents and beta-blockers. Physicians were also free to use other medications that could lower blood pressure.

The researchers found that the outcome of cardiovascular death, heart attack or stroke was modestly reduced when patients took telmisartan. In addition, fewer patients receiving telmisartan were hospitalized for any cardiovascular reason. Telmisartan was also remarkably well tolerated, and fewer patients on telmisartan discontinued the medication, according to the authors.

Telmisartan reduced the outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure by a relative 8 percent (17 percent in the placebo experienced those cardiac events compared to 15.8 percent in the telmisartan group). However, the authors noted that difference was not statistically significant.

When the outcome included cardiovascular death, heart attack or stroke (and not hospitalization for heart failure), telmisartan reduced that outcome by a significant 13 per cent (14.8 percent in the placebo group experienced those cardiac events compared to 13 percent with telmisartan).

“Although the benefit is of moderate size, there is an impact on a range of outcomes including the composite of cardiovascular death, myocardial infarction and strokes, as well as cardiovascular hospitalizations. Given the large proportion of people who are unable to tolerate an ACE inhibitor, the use of telmisartan would be clinically important,” said principal investigator Yusuf, director of the Population Health Research Institute at McMaster in Hamilton, Ontario.

The study, sponsored by Boehringer-Ingelheim, was conducted in 630 hospitals in 40 countries.