Image from WikipediaTelmisartan, Ramipril, or Both in Patients at High Risk for Vascular EventsACE Inhibitors in Cardiovascular Disease — Unbeatable?
Treatment of Hypertension in Patients 80 Years of Age or Older
Image from WikipediaTelmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events
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OnTarget was an important study because it was very well designed and answered a very important question. Do ARB's reduce events in the same way as ACEs. Are the therapies additive.
I think we can feel good about using ARBs in our ACE intolerant patients.
The only question is class effect...is generic lisinopril as good as (soon to be generic) ramipril. The jury is out, and that gets into the issue of Tissue ACE versus non-tissue ACE.
Telmesartan is essentially a "tissue ARB" in that it has a volume of distribution of 500L and consequently a 24 hour halflife. Other ARBs are less lipophillic and have to be dosed BID (losartan and valsartan).
The next megatrial frontier may be duels between the tissue and non-tissue RAAS blockers, or renin inhibitors being thrown into the mix.
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