Left Ventricular Mass and Volume With Telmisartan, Ramipril, or Combination in Patients With Previous Atherosclerotic Events or With Diabetes Mellitus (from the ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET])
Left Ventricular Mass and Volume With Telmisartan, Ramipril, or Combination in Patients With Previous Atherosclerotic Events or With Diabetes Mellitus (from the ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET])
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DOI：
10.1016/j.amjcard.2009.07.018
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发表时间：
2009-12-01
影响因子：
2.8
通讯作者：
Jennings, Garry L.
中科院分区：
文献类型：
--
作者：
Cowan, Brett R.;Young, Alistair A.;Jennings, Garry L.
正在进行的替米沙坦单独和与雷米普利全球终点试验(OnTarget)联合进行的研究表明，血管紧张素受体阻滞剂替米沙坦80毫克不逊于血管紧张素转换酶抑制剂雷米普利10毫克，在降低心血管疾病或高危糖尿病患者的发病率和死亡率方面，联合用药并不比雷米普利更有效。虽然以血管紧张素11为靶点的治疗已被认为可以减少左心室(LV)的质量和体积，但在这一人群中，血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂及其组合对心脏的相对影响尚不清楚。在OnTarget注册的287名患者中，对6个国家和地区的8个中心的287名患者进行了随机分组和治疗2年后的磁共振成像(雷米普利、替米沙坦和联合治疗组分别为90、100和97名患者)。与主要的OnTarget试验相比，基线患者特征显示冠状动脉疾病、亚裔种族以及他汀类药物和β受体阻滞剂的使用频率更高。除联合用药组左室重量指数下降幅度大于替米沙坦组(P=0.0001.0 4)外，其余各组间左室重量或容量变化均无显著差异。决定左心室重量减少的关键因素是高血压病史(p=0.03)、基线体重(p=0.03)。
The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) showed that the angiotensin receptor blocker telmisartan 80 mg was not inferior to the angiotensin-converting enzyme inhibitor ramipril 10 mg, and the combination no more effective than ramipril alone, in decreasing morbidity and mortality in patients with cardiovascular disease or high-risk diabetes. Although therapy targeting angiotensin 11 is known to decrease left ventricular (LV) mass and volume, the relative influence of angiotensin-converting enzyme inhibitor inhibitors and angiotensin receptor blocker, and their combination, on the heart remains unclear in this population. Magnetic resonance imaging was performed in 287 patients enrolled in ONTARGET, across 8 centers in 6 countries, at randomization and after 2-year treatment (90, 100, and 97 patients in the ramipril, telmisartan, and combination therapy groups, respectively). Baseline patient characteristics showed higher frequencies of coronary artery disease, Asian ethnicity, and use of statins and beta blockers than the main ONTARGET trial. LV mass decreased in all groups (p < 0.0001 for each), but there were no significant differences in change in LV mass or volume among groups, except that LV mass index decreased more on combination versus telmisartan (p = 0.04). Key determinants of LV mass decrease were a history of hypertension (p = 0.03), baseline mass (p