Telmisartan for the management of patients at high cardiovascular risk

Abstract

Background:

Cardiovascular disease (CVD) places a significant burden on healthcare providers. High blood pressure (BP) is the single most prevalent risk factor for CVD worldwide and is responsible for more deaths than any other risk factor. ‘Cardiovascular (CV) high-risk patients’ make up the broad cross-section of patients in the middle of the risk spectrum for CVD progression that is referred to as the CV continuum and includes those with atherothrombotic disease, those with target organ damage associated with type 2 diabetes and those with multiple risk factors. Angiotensin II is involved in CVD progression at every stage of the CV continuum, making the renin–angiotensin system a rational target for pharmacologic intervention. Angiotensin II receptor blockers (ARBs) offer a better tolerated alternative to angiotensin converting enzyme inhibitors, with greater long-term adherence. The ARB telmisartan recently received an indication for CV prevention.

Scope:

A PubMed literature search was conducted to identify evidence on the use of telmisartan for preventing CV events.

Findings:

Telmisartan has a favourable safety and tolerability profile, and has demonstrated efficacious and long-lasting 24-hour BP reductions, whether as monotherapy or in combination with hydrochlorothiazide or amlodipine. In the largest CV prevention trial program undertaken with an ARB (the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial; ONTARGET), telmisartan 80 mg/day alone was as effective as ramipril in reducing the composite primary endpoint of CV mortality, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure in CV high-risk patients. However, patients were significantly more likely to adhere to treatment with telmisartan than ramipril due to its better tolerability.

Conclusion:

To date, telmisartan is the only ARB indicated to reduce CV morbidity in a broad CV high-risk population.

Key words::

• Angiotensin II receptor blocker
• Cardiovascular disease
• Cardiovascular risk
• Renin angiotensin system
• Telmisartan

Transparency

Declaration of funding

L.M.R. received no compensation from any party related to the development of this manuscript.

Declaration of financial/other relationships

The author serves an advisor and speaker for Novartis, Bristol-Myers Squibb, Merck, Boehringer Ingelheim, Bayer, GlaxoSmithKline, Sanofiaventis, Pfizer, Menarini, and Abbott.

Acknowledgement

Writing and editorial assistance was provided by Tom Rees PhD of PAREXEL, which was contracted by Boehringer Ingelheim International GmbH for these services. The author meets criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and was fully responsible for all content and editorial decisions, and were involved at all stages of manuscript development.