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Impact of telmisartan on cardiovascular outcome in hypertensive patients at high risk: a Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease subanalysis.

AbstractBACKGROUND:
In the Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease, all patients were at high cardiovascular risk, and a substantial proportion were hypertensive. We performed a post-hoc analysis to explore the hypothesis that telmisartan has a differential action in hypertensive vs. nonhypertensive patients.
METHODS:
The primary four-fold endpoint (composite of cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure), the secondary three-fold endpoint (cardiovascular death, MI, and stroke), the individual components, new onset of left ventricular hypertrophy (LVH), and new onset of albuminuria were analyzed.
RESULTS:
There was no evidence for a significantly differential treatment effect of telmisartan in hypertensive and nonhypertensive patients for any endpoints, although the occurrence of the secondary three-fold endpoint was significantly lower in the telmisartan group (13.0%) compared with placebo (15.0%, P < 0.05) only in hypertensive patients. Moreover, data from this post-hoc analysis suggest that MI may be less frequent in hypertensive patients treated with telmisartan (3.8 vs. 5.1%; P < 0.05). Telmisartan may also reduce new onset of LVH (nonhypertensive patients P < 0.05; hypertensive patients P < 0.001) in both subgroups, and new onset of microalbuminuria and macroalbuminuria in hypertensive patients (P < 0.001 and P < 0.01, respectively).The effect of telmisartan in hypertensive and nonhypertensive patients at high cardiovascular risk was not different. This post-hoc analysis suggests that MI may be further reduced by telmisartan in hypertensive patients. Further investigations are needed to study the hypotheses raised by this explanatory analysis.
AuthorsSébastien Foulquier, Michael Böhm, Roland Schmieder, Peter Sleight, Koon Teo, Salim Yusuf, Helmut Schumacher, Thomas Unger
JournalJournal of hypertension (J Hypertens) Vol. 32 Issue 6 Pg. 1334-41 (Jun 2014) ISSN: 1473-5598 [Electronic] England
PMID24621807 (Publication Type: Journal Article, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antihypertensive Agents
  • Benzimidazoles
  • Benzoates
  • Telmisartan
Topics
  • Aged
  • Antihypertensive Agents (therapeutic use)
  • Benzimidazoles (therapeutic use)
  • Benzoates (therapeutic use)
  • Cardiovascular Diseases (prevention & control)
  • Cardiovascular System (drug effects)
  • Coronary Artery Disease (drug therapy)
  • Female
  • Follow-Up Studies
  • Heart Failure (prevention & control)
  • Hospitalization
  • Humans
  • Hypertension (drug therapy)
  • Hypertrophy, Left Ventricular (complications)
  • Male
  • Middle Aged
  • Myocardial Infarction (prevention & control)
  • Peripheral Vascular Diseases (drug therapy)
  • Stroke (prevention & control)
  • Telmisartan
  • Treatment Outcome

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