Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial
Open accessAbstract
Background Angiotensin-converting enzyme (ACE) inhibitors reduce major cardiovascular events, but are not tolerated by about 20% of patients. We therefore assessed whether the angiotensin-receptor blocker telmisartan would be effective in patients intolerant to ACE inhibitors with cardiovascular disease or diabetes with end-organ damage. Methods After a 3-week run-in period, 5926 patients, many of whom were receiving concomitant proven therapies, were randomised to receive telmisartan 80 mg/day (n=2954) or placebo (n=2972) by use of a central automated randomisation system. Randomisation was stratified by hospital. The primary outcome was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalisation for heart failure. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00153101. Findings The median duration of follow-up was 56 (IQR 51-64) months. All randomised patients were included in the efficacy analyses. Mean blood pressure was lower in the telmisartan group than in the placebo group throughout the study (weighted mean difference between groups 4.0/2.2 [SD 19.6/12.0] mm Hg). 465 (15.7%) patients experienced the primary outcome in the telmisartan group compared with 504 (17.0%) in the placebo group (hazard ratio 0.92, 95% CI 0.81-1.05, p=0.216). One of the secondary outcomes-a composite of cardiovascular death, myocardial infarction, or stroke-occurred in 384 (13.0%) patients on telmisartan compa…
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ACE inhibitors or ARB therapy have well-established long-term benefit in people with diabetes and CKD or hypertension.
“ACE inhibitors or ARB therapy also have well-established long-term benefit in people with diabetes and CKD or hypertension, and these agents are recommended for hypertension management in people with known ASCVD (particularly coronary artery disease) (72,73,246).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [73]
ACE inhibitors or ARB therapy have well-established long-term benefit in people with diabetes and CKD or hypertension.
“ACE inhibitors or ARB therapy also have well-established long-term benefit in people with diabetes and CKD or hypertension, and these agents are recommended for hypertension management in people with known ASCVD (particularly coronary artery disease) (66,67,238).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [67]
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- Authors
- ‡
- Corresponding author
- ‡
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 372
- Issue
- 9644
- Pages
- 1174-1183
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2160643831
- Cited by
- 1,000
- References
- 7
- Citations by year
- 2026: 10 · 2025: 22 · 2024: 30 · 2023: 35 · 2022: 29 · 2021: 37 · 2020: 34 · 2019: 28 · 2018: 41 · 2017: 60 · 2016: 51 · 2015: 53 · 2014: 58 · 2013: 67 · 2012: 100
- FWCI
- 82.47
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Boehringer Ingelheim
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
- Keywords
- telmisartan, angiotensin receptor blockers, ACE inhibitor intolerance, cardiovascular events, cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, blood pressure reduction, high-risk patients, cardiovascular disease, renin-angiotensin system blockade, antihypertensive therapy, cardiovascular risk stratification
- MeSH terms
- Telmisartan, Aged, Angioedema, Angiotensin-Converting Enzyme Inhibitors, Benzimidazoles, Benzoates, Cardiovascular Diseases, Cough, Female, Follow-Up Studies, Humans, Hypotension, Male, Therapeutic Equivalency, Single-Blind Method, Risk Reduction Behavior, Kaplan-Meier Estimate
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