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(Circulation. 2009;120:1380-1389.)
© 2009 American Heart Association, Inc.

Epidemiology and Prevention

Effects of Telmisartan, Ramipril, and Their Combination on Left Ventricular Hypertrophy in Individuals at High Vascular Risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease

Paolo Verdecchia, MD; Peter Sleight, MD; Giuseppe Mancia, MD; Robert Fagard, MD, PhD; Bruno Trimarco, MD; Roland E. Schmieder, MD; Jae-Hyung Kim, MD; Garry Jennings, MBBS, PhD; Petr Jansky, MD; Jyh-Hong Chen, MD; Lisheng Liu, MD; Peggy Gao, MSc; Jeffrey Probstfield, MD; Koon Teo, MD; Salim Yusuf, MD, DPhil, FRCPC, for the ONTARGET/TRANSCEND Investigators

From the Hospital S. Maria della Misericordia, Clinical Research Unit Preventive Cardiology, Perugia, Italy (P.V.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (P.V., P.G., K.T., S.Y.); Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK (P.S.); University of Milano-Bicocca, Milano, Italy (G.M.); Hypertension Unit, Catholic University of Leuven, Leuven, Belgium (R.F.); Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy (B.T.); Department of Nephrology and Hypertension, Friedrich Alexander University, Erlangen, Germany (R.E.S.); Department of Cardiology, St Paul’s Hospital, Catholic University of Korea, Division of Cardiology, Seoul, South Korea (J.-H.K.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (G.J.); University Hospital Motol, Department of Cardiovascular Surgery, Prague, Czech Republic (P.J.); National Cheng Kung University Medical College, Division of Cardiology, Department of Medicine, Tainan, Taiwan (J.-H.C.); Chinese Academy of Medical Sciences, Department of Hypertension, Fu Wai Hospital, Beijing, China (L.L.); and University of Washington, School of Public Health, Seattle (J.P.).

Correspondence to Paolo Verdecchia, MD, McMaster University, Population Health Research Institute, 237 Barton St E, Hamilton, ON L8L2X2 Canada. E-mail verdec{at}tin.it

Received December 5, 2008; accepted July 22, 2009.

Background— Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers reduce left ventricular hypertrophy (LVH). The effect of these drugs on LVH in high-risk patients without heart failure is unknown.

Methods and Results— In the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET), patients at high vascular risk and tolerant of ACE inhibitors were randomly assigned to ramipril, telmisartan, or their combination (n=23 165). In the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND), patients intolerant of ACE inhibitors were randomized to telmisartan or placebo (n=5343). Prevalence of LVH at entry in TRANSCEND was 12.7%. It was reduced by telmisartan (10.5% and 9.9% after 2 and 5 years) compared with placebo (12.7% and 12.8% after 2 and 5 years) (overall odds ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.0017). New-onset LVH occurred less frequently with telmisartan compared with placebo (overall odds ratio, 0.63; 95% CI, 0.51 to 0.79; P=0.0001). LVH regression was similar in the 2 groups. In ONTARGET, prevalence of LVH at entry was 12.4%. At follow-up, it occurred slightly less frequently with telmisartan (odds ratio, 0.92; 95% CI, 0.83 to 1.01; P=0.07) and the combination (odds ratio, 0.93; 95% CI, 0.84 to 1.02; P=0.12) than with ramipril, but differences between the groups were not significant. New-onset LVH was associated with a higher risk of primary outcome during follow-up (hazard ratio, 1.77; 95% CI, 1.50 to 2.07).

Conclusions— In patients at high vascular risk, telmisartan is more effective than placebo in reducing LVH. New-onset LVH is reduced by 37%. The effect of combination of the 2 drugs on LVH is similar to that of ramipril alone.

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Circulation 2009 120: 1337-1338. [Extract] [Full Text]