Effectiveness and Safety of Ramipril Alone Compared With Telmisartan Alone and in Combination With Ramipril in Patients at High Risk for Cardiovascular Events. Patients Intolerant to Ramipril Were Entered in TRANSCEND, Telmisartan Compared to Placebo.
Condition: Cardiovascular Diseases
MeSH terms: Cardiovascular Diseases
Intervention: Telmisartan; Combination of Telmisartan and Ramipril; Ramipril
Intervention MeSH terms: Telmisartan; Ramipril
Phase: Phase 4
Study type: Interventional
Primary purpose: Prevention
Intervention model: Parallel Assignment
Enrollment: 31546.0
Sex: All
Minimum age: 55 Years
Healthy volunteers: No

Summary:

      The Ongoing Telmisartan Alone and in combination wiht Ramipril Global Endpoint trial
      (ONTARGET): The primary objectives are to determine if (a) telmisartan 80mg daily and
      ramipril 10mg daily combination therapy is more effective in reducing the composite endpoint
      of Cardiovascular Death (CV) death, Myocardial infarction (MI), stroke or hospitalization for
      Congestive Heart Failure (CHF) compared with ramipril 10mg alone; and (b) telmisartan 80mg
      daily is at least as effective as (i.e. not less effective than) ramipril 10mg daily, on this
      endpoint.

      Telmisartan Randomised Assessment Study in Angiotension converting Enzyme inhibitor
      intolerant subjects with Cardiovascular Disease. (TRANSCEND): The primary objective of the
      study is to determine if treatment with telmisartan 80mg daily is superior to placebo
      reducing the composite endpoint of Cardiovascular Death (CV), Myocardial Infarction ( MI)I,
      stroke or hospitalization for Congestive Heart Failure (CHF) in patients who are intolerant
      to Angiotension Converting Enzyme inhibitors.
    

Eligibility criteria:

        Inclusion Criteria:

        Coronary Artery Disease: Previous Myocardial infarction(> 2 days prior to informed
        consent), or stable or previous unstable angina (> 30 days prior to informed consent) with
        documented multivessel coronary artery disease or a positive stress test, or multivessel
        Percutaneous Transluminal Coronary Angioplasty (> 30 days prior to informed consent), or
        previous multivessel Coronary Artery Bypass Grafting without angina (if surgery performed >
        4 years prior to informed consent) or with recurrent angina after surgery.

        Other High Risk:

          1. Peripheral Arterial Disease: Previous limb bypass surgery or angioplasty or
             amputation, intermittent claudication on history with ankle/arm Blood Pressure ratio <
             0.8 on at least one side, or significant stenosis by angiography or non-invasive
             testing

          2. Previous stroke

          3. Transient ischemic Attack > 7 days and < 1 year prior to informed consent

          4. Diabetes Mellitus (types I or II): with evidence of end-organ damage (retinopathy,
             Left ventricular hypertrophy, micro or macro albuminuria), or any evidence of previous
             cardiac or vascular disease.

        No definite and specific indication or contraindication for any of the study treatments.
        Written informed consent.

        Exclusion Criteria:

        A. Medication use:

          1. Inability to discontinue Angiotension Converting Enzyme (ACE) inhibitors or
             Angiotension 2 receptor antagonists (AIIAs).

          2. Patients with known hypersensitivity or intolerance to Angiotension 2 receptor
             antagonists (AIIAs) or Angiotension Converting Enzyme (ACE)inhibitors.

        NOTE: Patients with known intolerance to Angiotension Converting Enzyme inhibitor
        intolerance ( ACE-I) can be enrolled in the TRANSCEND study.

        B. Cardiovascular disease:

          1. Symptomatic congestive heart failure.

          2. Hemodynamically significant primary valvular or outflow tract obstruction (e.g. aortic
             or mitral valve stenosis, asymmetric septal hypertrophy, malfunctioning prosthetic
             valve).

          3. Constrictive pericarditis.

          4. Complex congenital heart disease.

          5. Syncopal episodes of unknown etiology < 3 months before informed consent.

          6. Planned cardiac surgery or angioplasty within three months.

          7. Uncontrolled hypertension on treatment (i.e.Blood pressure ( BP) > 160/100).

          8. Heart transplant recipient.

          9. Strokes due to subarachnoid hemorrhage

        C. Other conditions:

          1. Significant renal disease defined as:

               1. Renal artery stenosis;

               2. Creatinine clearance < 0.6 ml/min or serum creatinine > 265 umol/L (> 3.0 mg/dL);

               3. Hyperkalemia: potassium > 5.5 mmol/L.

               4. Proteinuria* (for TRANSCEND only).

          2. Hepatic dysfunction as defined by the following laboratory parameters: Serum Glutamate
             Pyruvate Transaminase( SGPT) Alaninaminotransferase (ALT) or Serum Glutamic
             Oxaloacetic Transaminase (SGOT) Aspartate aminotransferase (AST) > than 4 times upper
             limit of normal or additional criteria for hepatic impairment the upper limit of
             normal range, total Bilirubin > 20 umol/L, biliary obstructive disorders.

          3. Uncorrected volume depletion or sodium depletion.

          4. Primary aldosteronism.

          5. Hereditary fructose intolerance.

          6. Any other major non-cardiac illness expected to reduce life expectancy or interfere
             with study participation.

          7. Patient is simultaneously taking another experimental drug.

          8. Patient with significant disability that precludes regular attendance at clinic for
             follow-up.

          9. Patient has sufficient disability or other incapacity that precludes regular
             attendance at clinic for follow-up.

         10. Unable or unwilling to provide written informed consent.