Newer Blood Pressure Drug Shows Promise As Alternative To ACE Inhibitors For Some Patients

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Researchers in Canada engaged on a global examine, found that the angiotensin-receptor blocker (ARB) telmisartan, a more recent sort of

drug for reducing blood pressure, confirmed a modest discount in cardiovascular deaths, strokes and heart attacks in sufferers with coronary heart issues and

diabetes who cannot tolerate the usual and extra broadly used angiotensin-converting-enzyme (ACE) inhibitors.

The analysis was led by Drs Salim Yusuf and Koon Teo, professors within the Michael G. DeGroote College of Medication at McMaster College and

clinicians at Hamilton Well being Sciences, each based mostly in Hamilton, Ontario. The examine was printed on-line within the The Lancet on 31 August, and

offered on the European Society of Cardiology Congress 2008 being held in Munich, Germany, from 30 August to three September 2008.

ACE inhibitors enhance blood movement by widening blood vessels, however about 20 per cent of sufferers who may profit from ACE inhibitors cannot tolerate

them due to kidney issues, swelling, low blood stress or cough.

ARB additionally reduces blood stress however through a distinct route; it blocks receptors for the naturally occurring hormone angiotensin II that narrows blood

vessels and thereby improve blood stress.

The researchers reported the outcomes of the TRANSCEND (Telmisartan Randomized AssessmeNt Examine in ACE iNtolerant topics with

cardiovascular Illness) examine that recruited practically 6,000 sufferers in 630 hospitals in 40 nations. The mission was sponsored by the makers of

telmisartan, Boehringer-Ingelheim, whose headquarters are in Germany.

The sufferers have been all illiberal to ACE inhibitors, and had a historical past of heart problems or diabetes with end-organ harm. They have been

randomized to take both telmisartan or a placebo. Lots of the sufferers have been additionally in receipt of remedies resembling statins, anti-platelet brokers and

beta-blockers and their docs have been free to prescribe different blood stress decreasing medicine.

The outcomes confirmed that:

  • Cardiovascular deaths, coronary heart assaults or strokes have been modestly decreased within the group taking telmisartan in comparison with the placebo group.
  • There have been fewer hospitalizations among the many telmisartan sufferers, for any cardiovascular cause, in comparison with the placebo sufferers.
  • Telmisartan was effectively tolerated, and fewer sufferers stopped taking telmisartan in comparison with placebo.
  • There have been extra cardiovascular deaths, coronary heart assaults, strokes or hospitalizations for heart failure among the many placebo (17 per cent) than the

    telmisartan (15.eight per cent) group, however the distinction (eight per cent) was not statistically important (ie it may have been random).

  • However, when hospitalization for coronary heart failure was excluded, the distinction did grow to be statistically important (14.eight versus per cent, respectively,

    a distinction of 13 per cent).

Yusuf mentioned that the examine exhibits the worth of telmisartan as a substitute blood stress decreasing drug, and the end result, though modest, is clinically

necessary due to the big numbers of sufferers who cannot tolerate ACE inhibitors.

“Though the profit is of average dimension, there may be an affect on a variety of outcomes together with the composite of cardiovascular loss of life, myocardial

infarction and strokes, in addition to cardiovascular hospitalizations,” mentioned Yusuf.

Teo added that:

“The exceptional tolerability of telmisartan is emphasised by the truth that fewer people cease medicine in the event that they have been receiving telmisartan

in comparison with placebo.”

“Results of the angiotensin-receptor blocker telmisartan on cardiovascular occasions in high-risk sufferers illiberal to angiotensin-converting

enzyme inhibitors: a randomised managed trial.”
The Telmisartan Randomised AssessmeNt Examine in ACE iNtolerant topics with cardiovascular Illness (TRANSCEND) Investigators.
The Lancet, printed on-line, 31 August 2008.
Additionally offered at European Society of Cardiology Congress 2008.

Click here for Abstract

in The Lancet.

Click here for a clinical summary of the

trial (Cardiosource).

Sources: McMaster College, Cardiosource.

Written by: Catharine Paddock, PhD

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