Angiotensin-converting enzyme inhibitors (ACEIs) and
angiotensin receptor blockers (ARBs) have shown cardioprotective and renoprotective properties. These agents are recommended as first-line
therapy for the treatment of
hypertension and the reduction of cardiovascular risk. Early studies pointed to the cardioprotective and renoprotective effects of ARBs in high-risk patients. The ONgoing
Telmisartan Alone and in combination with
Ramipril Global Endpoint Trial (ONTARGET) established the clinical equivalence of the cardioprotective and renoprotective effects of
telmisartan and
ramipril, but did not find an added benefit of the combination over
ramipril alone. Similar findings were observed in the
Telmisartan Randomized AssessmeNt Study in aCE INtolerant subjects with
cardiovascular Disease (TRANSCEND) trial conducted in ACEI-intolerant patients. In ONTARGET,
telmisartan had a better tolerability profile with similar renoprotective properties compared with
ramipril, suggesting a potential clinical benefit over
ramipril. The recently completed
Olmesartan Reducing Incidence of Endstage Renal Disease in
Diabetic Nephropathy Trial (ORIENT) and
Olmesartan and
Calcium Antagonists Randomized (OSCAR) studies will further define the role of ARBs in cardioprotection and renoprotection for high-risk patients.