Evidence map›Paper›PMID 18378520›Full record

Trial reportThe New England journal of medicine2008

Telmisartan, ramipril, or both in patients at high risk for vascular events.

ONTARGET Investigators, Salim Yusuf, Koon K Teo, Janice Pogue, Leanne Dyal, Ingrid Copland, Helmut Schumacher, Gilles Dagenais, Peter Sleight, Craig Anderson

2 registry-linked trialsOpen access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1,040 papers, 23 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,040citing papers in PubMed, 23 pooled it
238.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00153101 phase4completednot on this map

ONTARGET ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial A Large, Simple Randomized Trial of an Angiotensin II Receptor Antagonist (Telmisartan) and an ACE-Inhibitor (Ramipril) in Patients at High Risk for Cardiovascular Events and TRANSCEND Telmisartan Randomized AssessmeNt Study in aCE iNtolerant Subjects With Cardiovascular Disease. A Parallel Study Comparing the Effects of Telmisartan With Placebo and Outcomes in Patients at High Risk for Cardiovascular Events and Intolerant to ACE-I.

TypeinterventionalSponsorBoehringer IngelheimRan2001Enrolled31,546ConditionsCardiovascular DiseasesArmsTelmisartan, Combination of Telmisartan and Ramipril, Ramipril
NCT01945268 phase4completednot on this mapstarted 2015, after this paper: background citation

A Randomized Controlled Trial of Influenza Vaccine to Prevent Adverse Vascular Events: A Pilot Study

TypeinterventionalSponsorMcMaster UniversityRan2015 to 2015Enrolled107ConditionsHeart FailureArmsinactivated trivalent influenza vaccine, Sterile saline
3 · Its place in the literature

Who cites it

1,040 citing papers in PubMed, 23 syntheses or guidelines pooled it, 3,505 citations in OpenAlex.

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  5. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025
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  6. Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025
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  14. Non-immunosuppressive treatment for IgA nephropathy.The Cochrane database of systematic reviews · 2024
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  16. The association between dual RAAS inhibition and risk of acute kidney injury and hyperkalemia in patients with diabetic kidney disease: a systematic review and meta-analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023
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980 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

ONTARGET InvestigatorsPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. yusufs@mcmaster.ca
Salim Yusuf
Koon K Teo
Janice Pogue
Leanne Dyal
Ingrid Copland
Helmut Schumacher
Gilles Dagenais
Peter Sleight
Craig Anderson
Population Health Research Institute · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-converting-enzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs) in such patients is unknown. We compared the ACE inhibitor ramipril, the ARB telmisartan, and the combination of the two drugs in patients with vascular disease or high-risk diabetes.

methodsAfter a 3-week, single-blind run-in period, patients underwent double-blind randomization, with 8576 assigned to receive 10 mg of ramipril per day, 8542 assigned to receive 80 mg of telmisartan per day, and 8502 assigned to receive both drugs (combination therapy). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure.

resultsMean blood pressure was lower in both the telmisartan group (a 0.9/0.6 mm Hg greater reduction) and the combination-therapy group (a 2.4/1.4 mm Hg greater reduction) than in the ramipril group. At a median follow-up of 56 months, the primary outcome had occurred in 1412 patients in the ramipril group (16.5%), as compared with 1423 patients in the telmisartan group (16.7%; relative risk, 1.01; 95% confidence interval [CI], 0.94 to 1.09). As compared with the ramipril group, the telmisartan group had lower rates of cough (1.1% vs. 4.2%, P<0.001) and angioedema (0.1% vs. 0.3%, P=0.01) and a higher rate of hypotensive symptoms (2.6% vs. 1.7%, P<0.001); the rate of syncope was the same in the two groups (0.2%). In the combination-therapy group, the primary outcome occurred in 1386 patients (16.3%; relative risk, 0.99; 95% CI, 0.92 to 1.07); as compared with the ramipril group, there was an increased risk of hypotensive symptoms (4.8% vs. 1.7%, P<0.001), syncope (0.3% vs. 0.2%, P=0.03), and renal dysfunction (13.5% vs. 10.2%, P<0.001).

conclusionsTelmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit. (ClinicalTrials.gov number, NCT00153101 [ClinicalTrials.gov].).

Indexed as

AgedAngioedemaAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersBenzimidazolesBenzoatesBlood PressureCardiovascular DiseasesCreatinineDiabetes MellitusDouble-Blind MethodDrug Therapy, CombinationFemaleFollow-Up StudiesHospitalizationHumansAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersBenzimidazolesBenzoatesCreatinineRamiprilTelmisartan

Identifiers

PMID18378520
OpenAlexW2152798629

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.