ONTARGET

• Telmisartan (16.7%) noninferior; combination (16.3%) not superior to ramipril (16.5%) for primary endpoint (CV death, MI, stroke, heart failure)

• Greater incidence of hypotension in combination (4.8%) and telmisartan (2.7%) groups, compared with ramipril group (1.7%) (p < 0.001)

Trial design: Patients at high risk for cardiovascular events, but without heart failure, were randomized to telmisartan, ramipril, or the combination. Patients were followed for a median of 56 months.

Results

Conclusions

The ONTARGET investigators. N Engl J Med 2008;358:1547-59

Telmisartan(n = 8,542)

Combination(n = 8,502)

• Either telmisartan or ramipril, but not both, can be used in hypertensive patients at high risk for cardiovascular events

• Side effects greater with combination therapy

16.7 16.3

%

0

10

Primary endpoint

20

Ramipril(n = 8,576)

16.5

0

10

15

5

Mortality

11.6 12.5 11.8

%

(p < 0.004*) (p = ns)

* Telmisartan vs. ramipril for noninferiority