The study found a new drug telmisartan is as effective as the popular drug ramipril in reducing cardiovascular death in high risk patients and it has fewer side effects.
Dr. Salim Yusuf, director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences and principal investigator of the study, presented the results of ONTARGET today at the American College of Cardiology conference. The paper has also been published on-line by the New England Journal of Medicine.
Previous studies such as the Heart Outcomes Prevention Evaluation Trial (HOPE) demonstrated that angiotensin converting enzyme (ACE) inhibitors such as ramipril reduce cardiovascular death, myocardial infarction, strokes and heart failure in high risk individuals, however, a significant proportion (about 20 percent) of patients are unable to tolerate an ACE-inhibitor due side effects such as coughing, hypotension or swelling.
An alternate therapy, telmisartan, which is an angiotensin II receptor blocker, proved to be at least as effective and better tolerated, offering clinicians and patients an important alternative.
“This study is of clinical importance because it demonstrates that telmisartan is an effective and safe alternative to ramipril. This means both patients and physicians have choices and can use telmisartan where appropriate with a high degree of confidence,” said Yusuf, a professor of the Michael G. DeGroote School of Medicine at McMaster. Dr. Yusuf is also vice-president of research and chief scientific officer at Hamilton Health Sciences.
Investigators from 733 centers in 40 countries collaborated in conducting the ONTARGET study, which enrolled 25,620 patients with coronary heart disease or diabetes plus additional risk factors and were over the age of 55 years of age, but did not have evidence of heart failure. Patients were randomized to receive ramipril 10-mg a day, telmisartan 18-mg a day or the combination of the two. The mean duration of follow-up of the study was 55 months.
Telmisartan and ramipril were found to be equally effective but telmisartan was better tolerated than ramipril with the chief differences being lower rates of coughing and lower rates of angioneurotic edema (a life-threatening swelling of the throat and airways). There was a small excess of minor symptoms related to hypotension such as dizziness with telmisartan.
“All people who have cardiovascular disease or diabetes with organ target damage and physicians managing these diseases should be interested in the results of this important trial,” said Dr. Gilles Dagenais, cardiologist at the Laval University Heart and Lung Institute, Quebec City, and one of the Canadian national co-ordinators of the ONTARGET trial. “If it’s possible to have access to a medication that can prevent serious cardiovascular events but with fewer side effects and better compliance than what’s currently available, it will also have a great impact on their quality of life.”
Dr. Koon Teo, professor of medicine at McMaster University and head of clinical trials in the Population Health Research Institute at Hamilton Health Sciences, said: “The ONTARGET trial is very important because it addresses the question of how we can best prevent heart attack, stroke, heart failure, cardiovascular death and other outcomes such as diabetes. These conditions affect millions of people around the world and if we can find a better treatment that improves these outcomes we’re doing a lot of good.”
Surprisingly, combination therapy did not offer any additional benefit but was associated with a higher rate of hypotension related side effects including fainting. There was also an increase in discontinuations for hyperkalemia (high potassium levels).
Veronica McGuire | EurekAlert!
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
20.10.2017 | Information Technology
20.10.2017 | Materials Sciences
20.10.2017 | Interdisciplinary Research