Evidence map›Paper›PMID 18707986›Full record

Trial reportLancet (London, England)2008

Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial.

Johannes F E Mann, Roland E Schmieder, Matthew McQueen, Leanne Dyal, Helmut Schumacher, Janice Pogue, Xingyu Wang, Aldo Maggioni, Andrzej Budaj, Suphachai Chaithiraphan and 10 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Lancet (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00153101 (ONTARGET ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial A Large, Simple Randomized Trial of an Angiotensin II Receptor Antagonist), which is not on this map. Cited by 498 papers, 22 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
498citing papers in PubMed, 22 pooled it
100.9field-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
3 · Its place in the literature

Who cites it

498 citing papers in PubMed, 22 syntheses or guidelines pooled it, 1,585 citations in OpenAlex.

  1. Pooled it
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  7. Non-immunosuppressive treatment for IgA nephropathy.The Cochrane database of systematic reviews · 2024
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  9. Guideline
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  12. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
  13. Correlation between adverse events after drug treatment and theThe Journal of international medical research · 2019
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  14. A meta-analysis ofThe Journal of international medical research · 2019
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  16. Guideline
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  18. Glycemic Control for Patients With Type 2 Diabetes Mellitus: Our Evolving Faith in the Face of Evidence.Circulation. Cardiovascular quality and outcomes · 2016 · on this map
    Pooled it
  19. Guideline
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438 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 15 institutions in 12 countries.

Johannes F E MannSchwabing General Hospital, and KfH Kidney Centre, Ludwig Maximilians University Munchen, Germany.
Roland E Schmieder
Matthew McQueen
Leanne Dyal
Helmut Schumacher
Janice Pogue
Xingyu Wang
Aldo Maggioni
Andrzej Budaj
Suphachai Chaithiraphan
Kenneth Dickstein
Matyas Keltai
Kaj Metsärinne
Ali Oto
Alexander Parkhomenko
Leopoldo S Piegas
Tage L Svendsen
Koon K Teo
Salim Yusuf
ONTARGET investigators
Population Health Research Institute · CAMcMaster University · CAAssociazione Nazionale Medici Cardiologi Ospedalieri · ITBangkok Hospital · THBoehringer Ingelheim (Germany) · DEFriedrich-Alexander-Universität Erlangen-Nürnberg · DEFu Wai Hospital · CNGottsegen National Cardiovascular Center · HUGrochowski Hospital · PLHacettepe University · TRHolbæk Sygehus · DKInstituto Dante Pazzanese de Cardiologia · BRMünchen Klinik Schwabing · DEStavanger University Hospital · NOTurku University Hospital · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAngiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors are known to reduce proteinuria. Their combination might be more effective than either treatment alone, but long-term data for comparative changes in renal function are not available. We investigated the renal effects of ramipril (an ACE inhibitor), telmisartan (an ARB), and their combination in patients aged 55 years or older with established atherosclerotic vascular disease or with diabetes with end-organ damage.

methodsThe trial ran from 2001 to 2007. After a 3-week run-in period, 25 620 participants were randomly assigned to ramipril 10 mg a day (n=8576), telmisartan 80 mg a day (n=8542), or to a combination of both drugs (n=8502; median follow-up was 56 months), and renal function and proteinuria were measured. The primary renal outcome was a composite of dialysis, doubling of serum creatinine, and death. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00153101.

findings784 patients permanently discontinued randomised therapy during the trial because of hypotensive symptoms (406 on combination therapy, 149 on ramipril, and 229 on telmisartan). The number of events for the composite primary outcome was similar for telmisartan (n=1147 [13.4%]) and ramipril (1150 [13.5%]; hazard ratio [HR] 1.00, 95% CI 0.92-1.09), but was increased with combination therapy (1233 [14.5%]; HR 1.09, 1.01-1.18, p=0.037). The secondary renal outcome, dialysis or doubling of serum creatinine, was similar with telmisartan (189 [2.21%]) and ramipril (174 [2.03%]; HR 1.09, 0.89-1.34) and more frequent with combination therapy (212 [2.49%]: HR 1.24, 1.01-1.51, p=0.038). Estimated glomerular filtration rate (eGFR) declined least with ramipril compared with telmisartan (-2.82 [SD 17.2] mL/min/1.73 m(2)vs -4.12 [17.4], p<0.0001) or combination therapy (-6.11 [17.9], p<0.0001). The increase in urinary albumin excretion was less with telmisartan (p=0.004) or with combination therapy (p=0.001) than with ramipril.

interpretationIn people at high vascular risk, telmisartan's effects on major renal outcomes are similar to ramipril. Although combination therapy reduces proteinuria to a greater extent than monotherapy, overall it worsens major renal outcomes.

Indexed as

AgedAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersBenzimidazolesBenzoatesCardiovascular DiseasesCreatinineDiabetes MellitusDouble-Blind MethodDrug Therapy, CombinationFollow-Up StudiesGlomerular Filtration RateHumansKidneyMiddle AgedProteinuriaAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersBenzimidazolesBenzoatesCreatinineRamiprilTelmisartan

Identifiers

PMID18707986
OpenAlexW2100409734

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.