Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

This large trial compared the angiotensin-receptor blocker telmisartan, the angiotensin-converting–enzyme inhibitor ramipril, and combination therapy with both drugs in patients with vascular disease or high-risk diabetes. Outcomes were the same with telmisartan and ramipril, and there were more adverse events with combination therapy. This trial compared the angiotensin-receptor blocker telmisartan, the angiotensin-converting–enzyme inhibitor ramipril, and combination therapy in patients with vascular disease or high-risk diabetes. Outcomes were the same with telmisartan and ramipril, and there were more adverse events with combination therapy. Randomized, controlled trials involving about 150,000 patients have convincingly demonstrated that angiotensin-converting–enzyme (ACE) inhibitors reduce rates of death, myocardial infarction, stroke, and heart failure among patients with heart failure, 1 left ventricular dysfunction, 2 – 4 previous vascular disease alone, 5 – 7 or high-risk diabetes. 8 ACE inhibitors do not block the production of all angiotensin II, so direct receptor blockade might be more effective. ACE inhibitors reduce bradykinin degradation, which enhances vasodilatation, but increase the rates of angioedema and cough. In patients with heart failure, angiotensin II levels may increase and symptoms worsen, despite the use of ACE inhibitors. 9 The use of an angiotensin-receptor . . .