Study shows telmisartan reduces outcome of cardiovascular death

An
international study led by Canadian researchers has found that
telmisartan, a medication used to lower blood pressure, reduced the
outcome of cardiovascular death, heart attack or stroke in people who
are unable to tolerate a widely available and effective standard
treatment, says eurekalert press release.

Dr. Salim Yusuf and Dr. Koon Teo,
professors in the Michael G. DeGroote School of Medicine at McMaster
University and clinicians at Hamilton Health Sciences, led the study.
Today the research results will be published online by The Lancet and
presented at this year's European Society of Cardiology Congress in
Munich, Germany.

ACE inhibitors, or
angiotensin-converting-enzyme inhibitors, are widely used and effective
medications used to lower blood pressure. They work by helping to widen
blood vessels to improve blood flow. Approximately 20 per cent of
patients who could benefit from an ACE inhibitor stop taking it because
of cough, kidney problems, swelling or symptomatic low blood pressure.

Telmisartan is a type of
angiotensin-receptor blocker, or ARB. Like ACE inhibitors, telmisartan
also lowers blood pressure, but works in a different manner. ARBs block
the receptor sites in the body for angiotensin II, a naturally
occurring hormone that constricts blood vessels and increases blood
pressure.

The TRANSCEND (Telmisartan Randomized
AssessmeNt Study in ACE iNtolerant subjects with cardiovascular
Disease) study enrolled nearly 6,000 people worldwide who are
intolerant to ACE inhibitors, and evaluated whether telmisartan —
compared to placebo — would reduce the risk of major cardiovascular
events. A high proportion of patients received proven therapies, such
as statins, anti-platelet agents and beta-blockers. Physicians were
also free to use other medications that could lower blood pressure.

The researchers found that the outcome
of cardiovascular death, heart attack or stroke was modestly reduced
when patients took telmisartan. In addition, fewer patients receiving
telmisartan were hospitalized for any cardiovascular reason compared to
placebo. Telmisartan was also remarkably well tolerated, and fewer
patients on telmisartan discontinued the medication compared to
placebo.

Telmisartan reduced the outcome of
cardiovascular death, heart attack, stroke or hospitalization for heart
failure by a relative eight per cent (17 per cent in the placebo
experienced those cardiac events compared to 15.8 per cent in the
telmisartan group). This difference was not statistically significant.

However, when the outcome included
cardiovascular death, heart attack or stroke (and not hospitalization
for heart failure), telmisartan reduced that outcome by a significant
13 per cent (14.8 per cent in the placebo group experienced those
cardiac events compared to 13 per cent with telmisartan).

"The TRANSCEND study demonstrates the
value of telmisartan in people who are unable to tolerate angiotensin
converting enzyme inhibitors," said principal investigator Dr. Yusuf,
director of the Population Health Research Institute at McMaster
University.

"Although the benefit is of moderate
size, there is an impact on a range of outcomes including the composite
of cardiovascular death, myocardial infarction and strokes, as well as
cardiovascular hospitalizations. Given the large proportion of people
who are unable to tolerate an ACE inhibitor, the use of telmisartan
would be clinically important."

"The remarkable tolerability of
telmisartan is emphasized by the fact that fewer individuals stop
medication if they were receiving telmisartan compared to placebo,"
said Dr. Teo, the project director. "This is particularly noteworthy,
as all the individuals enrolled in the study were unable to tolerate an
ACE inhibitor, which is a closely related class of agents."