Vol 12, No 6 (2008)
Review paper
Published online: 2008-12-11
ACE-inhibitors and sartans - will large trials results published in 2008 change our every-day clinical practice?
Piotr Jankowski, Danuta Czarnecka
Nadciśnienie tętnicze 2008;12(6):444-453.
Vol 12, No 6 (2008)
REVIEV
Published online: 2008-12-11
Abstract
Sartans have been available for over 10 years. However, the
debate concerning the adventage of sartans vs ACE inhibitors
is still ongoing. Recently published results of large clinical
trials have provided new arguments in this debate. Moreover,
the benefits of sartans combined with ACE inhibitors have
been widely suggested. One of the large trials published in
2008 also provides some new data in this field. The new published
results suggest that telmisartan can be considered as an
alternative agent for ramipril in patients with symptomatic
atherosclerosis or diabetes, however, some important concerns
were raised by significantly faster reduction of glomerular flow
rate related to the use of telmisartan (ONTARGET trial).
TRANSCEND trial showed that telmisartan moderately reduces
the risk of cardiovascular death/stroke/myocardial infarction
in intolerant to ACE inhibitors patients with symptomatic
atherosclerosis or diabetes. However, there was no reduction
in hospitalisations due to heart failure in this
population. ONTARGET Trial Investigators failed to show
any benefit from combination therapy consisted of ramipril
and telmisartan. On the other hand this combination was
related to higher frequency of of side effects, especially renal
ones. Taking all the above into account it seems that the
published in 2008 large clinical trials will not change actual
guidelines concering treatment of hypertension in patients
with symptomatic atherosclerosis or diabetes. ACE inhibitors
remain the drugs of choice for these patients.
Abstract
Sartans have been available for over 10 years. However, the
debate concerning the adventage of sartans vs ACE inhibitors
is still ongoing. Recently published results of large clinical
trials have provided new arguments in this debate. Moreover,
the benefits of sartans combined with ACE inhibitors have
been widely suggested. One of the large trials published in
2008 also provides some new data in this field. The new published
results suggest that telmisartan can be considered as an
alternative agent for ramipril in patients with symptomatic
atherosclerosis or diabetes, however, some important concerns
were raised by significantly faster reduction of glomerular flow
rate related to the use of telmisartan (ONTARGET trial).
TRANSCEND trial showed that telmisartan moderately reduces
the risk of cardiovascular death/stroke/myocardial infarction
in intolerant to ACE inhibitors patients with symptomatic
atherosclerosis or diabetes. However, there was no reduction
in hospitalisations due to heart failure in this
population. ONTARGET Trial Investigators failed to show
any benefit from combination therapy consisted of ramipril
and telmisartan. On the other hand this combination was
related to higher frequency of of side effects, especially renal
ones. Taking all the above into account it seems that the
published in 2008 large clinical trials will not change actual
guidelines concering treatment of hypertension in patients
with symptomatic atherosclerosis or diabetes. ACE inhibitors
remain the drugs of choice for these patients.
Keywords
hypertension; atherosclerosis; cardiovascular risk; ACE inhibitors; sartans
Title
ACE-inhibitors and sartans - will large trials results published in 2008 change our every-day clinical practice?
Journal
Arterial Hypertension
Issue
Vol 12, No 6 (2008)
Article type
Review paper
Pages
444-453
Published online
2008-12-11
Page views
650
Article views/downloads
2253
Bibliographic record
Nadciśnienie tętnicze 2008;12(6):444-453.
Keywords
hypertension
atherosclerosis
cardiovascular risk
ACE inhibitors
sartans
Authors
Piotr Jankowski
Danuta Czarnecka
About this article