�The angiotensin-receptor blocker (ARB) telmisartan should be regarded as a potential intervention for vascular disease or high-risk diabetes, in the 20% of patients world Health Organization are ineffectual to permit the standard treatment of angiotensin-converting enzyme (ACE) inhibitors. These ar the conclusions of the TRANSCEND study, published in an Article early Online and in an upcoming edition of The Lancet, which is being presented at the European Society of Cardiology meeting in Munich and is authored by Dr Salim Yusuf, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
This randomised controlled trial analysed 5926 patients with vascular disease or high risk diabetes and taking other proven therapies, of whom 2954 received telmisartan 80 mg/day and 2972 received placebo. The primary termination of the trial was a combination of cardiovascular death, mettle attack, chance event, or hospitalization for heart failure. Patients were followed-up for a median of 56 months.
The researchers found that mean blood pressure was lower in the telmisartan group than placebo by 4�0/2�2 mm Hg. The primary final result was experient by 465 (15�7%) patients given telmisartan compared with 504 (17�0%) in the placebo radical, although the benefit for telmisartan was not statistically significant. One of the secondary outcomes-a combination of cardiovascular death, heart attack or stroke-occurred in 384 (13�0%) of patients on telmisartan compared with 440 (14�8%) on placebo-a congener risk reduction of 13% for telmisartan patients, although this finding was of borderline statistical significance. A lower proportion of telmisartan patients (894/30�3%) were hospitalised for cardiovascular reasons than in the placebo grouping (980/33�0%): this result was statistically significant. Finally, fewer patients permanently discontinued medication in the telmisartan chemical group (639/21�6%) than in the placebo group (705/23�8%) (boundary line statistical implication). The virtually common reason for permanent discontinuation was symptoms of low rip pressure (hypotension) in both groups.
The authors close: "These information suggest that telmisartan confers a lowly benefit when added to other proved therapies. In view of the drug's tolerability and effects on cardiovascular endpoints, telmisartan could be regarded as a potential treatment for patients with vascular disease or high-risk diabetes, if they are unable to tolerate an ACE inhibitor."
In an accompanying Comment, Dr Toni L Ripley and Dr Donald Harrison, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA, say: "ARBs that have been studied in coronary disease are safe, but possibly less efficient alternatives in patients with intolerance to ACE inhibitors. Although data are excessively limited to reach classical conclusions, the clinical force of ARBs seems less robust than that of ACE inhibitors."
The Lancet
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