Telmisartan, ramipril, or both in patients at high risk for vascular events
Telmisartan, ramipril, or both in patients at high risk for vascular events
复制标题
DOI：
10.1056/nejmoa0801317
复制
发表时间：
2008-04-10
影响因子：
158.5
通讯作者：
Anderson, Craig
中科院分区：
文献类型：
--
作者：
Yusuf, Salim;Teo, Koon K.;Anderson, Craig
背景资料：在患有血管疾病或高危糖尿病但不伴有心力衰竭的患者中，血管紧张素转换酶（ACE）抑制剂可降低心血管原因导致的死亡率和发病率，但血管紧张素受体阻滞剂（ARB）在此类患者中的作用尚不清楚。我们比较了血管紧张素转换酶抑制剂雷米普利、血管紧张素转换酶抑制剂替米沙坦以及两种药物联合治疗血管疾病或高危糖尿病患者的疗效。经过3周的单盲导入期后，患者接受双盲随机分组，8576例患者被分配接受每日10 mg雷米普利，8542例患者被分配接受每日80 mg替米沙坦，8502被分配接受两种药物（联合治疗）。主要复合终点为心血管原因死亡、心肌梗死、中风或因心力衰竭住院治疗。结果：替米沙坦组（0.9/0.6 mm Hg更大的降低）和联合治疗组（2.4/1.4 mm Hg更大的降低）的平均血压均低于雷米普利组。在中位随访56个月时，雷米普利组有1412例患者（16.5%）发生主要结局，而替米沙坦组有1423例患者（16.7%;相对风险，1.01; 95%置信区间[CI]，0.94 - 1.09）。与雷米普利组相比，替米沙坦组咳嗽发生率较低（1.1% vs.4.2%，P
Background: In 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.Methods: After 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.Results: Mean 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