title: 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.
abstract: BACKGROUND
  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.
authors.affiliation: aCARIM, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands bKlinik für Innere Medizin III, University Clinic of the Saarland, Homburg/Saar cDepartment of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany dCardiovascular Medicine, John Radcliffe Hospital, Oxford, UK ePopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada fBoehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Foulquier
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Roland
authors.initials: R
authors.lastname: Schmieder
authors.forename: Peter
authors.initials: P
authors.lastname: Sleight
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Helmut
authors.initials: H
authors.lastname: Schumacher
authors.forename: Thomas
authors.initials: T
authors.lastname: Unger
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002319:Cardiovascular System / Q000187:drug effects; D003324:Coronary Artery Disease / Q000188:drug therapy; D005500:Follow-Up Studies; D006333:Heart Failure / Q000517:prevention & control; D006760:Hospitalization; D006973:Hypertension / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D009203:Myocardial Infarction / Q000517:prevention & control; D016491:Peripheral Vascular Diseases / Q000188:drug therapy; D020521:Stroke / Q000517:prevention & control; D000077333:Telmisartan; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D000077333:Telmisartan