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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ETelmisartan did not reduce the primary composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure in patients with diabetes or high-risk vascular disease who are unable to tolerate standard treatment with angiotensin-converting enzyme inhibitors, according to findings from the Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease [TRANSCEND; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00153101\u0026amp;atom=%2Fspmdc%2F8%2F6%2F16.atom\u0022\u003ENCT00153101\u003C\/a\u003E] Trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThe angiotensin receptor blocker (ARB) telmisartan did not reduce the primary composite of cardiovascular (CV)death, myocardial infarction (MI), stroke, or hospitalization for heart failure in patients with diabetes or high-risk vascular disease who are unable to tolerate standard treatment with angiotensin-converting enzyme (ACE) inhibitors, researchers report.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EFindings from the TRANSCEND trial (Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00153101\u0026amp;atom=%2Fspmdc%2F8%2F6%2F16.atom\u0022\u003ENCT00153101\u003C\/a\u003E) were presented in Munich at the 2008 European Society of Cardiology Congress in a late-breaking clinical trial session.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EWhile telmisartan treatment did not reach statistical significance compared with placebo for the primary outcome of the study, it did significantly reduce the composite of CV death, heart attack, or stroke, as reported by investigator Koon Teo, MD, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. \u201cEven though the benefit was moderate, there was an impact on a wide range of outcomes. Because a large proportion of people are unable to tolerate an ACE inhibitor, the use of telmisartan among such patients could become clinically important,\u201d he added.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EFollowing a 3-week run-in period, 5926 subjects who were ACE-intolerant were randomized to receive telmisartan 80 mg\/day (n=2954) or placebo (n=2972) plus other proven therapies. Patient characteristics were similar in both groups. Mean age was 66.9 \u00b1 7.3 years, 43% was female, 76% had hypertension, and 35.7% had diabetes. Mean blood pressure was 141.0 \u00b1 16.6\/81.9 \u00b1 10.1 mm Hg. Fasting plasma glucose was 6.50 \u00b1 2.44 mmol\/L. Mean total cholesterol was 5.09 \u00b1 1.16 mmol\/L (91.6 +\/- 20.9 mg\/dL).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ESubjects were assessed at 6 weeks, 6 months, and every 6 months thereafter. Primary outcome events were adjudicated by a blinded central committee. The authors noted that because most of the subjects entered the trial with pre-existing CV disease, deaths were classified as CV-related unless an unequivocal noncardiovascular cause was determined.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe median duration of follow-up was 56 months. The researchers were able to ascertain vital status in 5908 (99.7%) of the subjects. Of the 2122 (80.8%) telmisartan subjects who were still using the drug at the end of the study, 2086 (79.4%) were on a full dose and 36 (1.4%) were on a reduced dose.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ENonstudy ARBs were used by 54 (1.8%) of the telmisartan subjects and 84 (2.9%) of placebo subjects at Year 1, increasing to 152 (5.8%) and 200 (7.6%), respectively, by the end of the study. Other nonstudy blood pressure-lowering drugs were used less frequently in patients who were randomized to telmisartan compared with placebo: diuretics, 888 (33.7%) versus 1059 (40.0%; p\u0026lt;0.0001); calcium channel blockers, 1003 (38.0%) versus 1215 (45.9%; p\u0026lt;0.0001); beta-blockers, 1492 (56.6%) versus 1561 (59.0%; p=0.081); and alpha-blockers, 140 (5.3%) versus 197 (7.5%; p=0.0002). The use of statins (1683 [63.6%] vs 1671 (63.1%]; p=0.588) and antiplatelet agents (2025 [76.8%] vs 2040 [77.0%]; p=0.831) were similar in both cohorts following randomization, and the rates remained constant during the study.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThroughout the study, mean blood pressure was lower in the telmisartan cohort than in the placebo cohort, with a weighted mean difference between the groups of 4.0 \u00b1 19.6\/2.2 \u00b1 12.0 mm Hg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EA total of 465 (15.7%) of the patients who were randomized to telmisartan experienced a primary endpoint event (death, heart attack, stroke, or hospitalization for heart failure), compared with 504 (17%) patients in the placebo group (HR 0.92, 95% CI, 0.81\u20131.05; p=0.22).\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EFor one of the prespecified secondary outcomes\u2014a composite of CV death, MI, or stroke\u2014386 (13.0%) of the patients who were assigned telmisartan experienced events, compared with 440 (14.8%) who were assigned placebo (HR 0.87, 95% CI, 0.76\u20131.00; p=0.048). The investigators reported that 894 (30.3%) of the telmisartan subjects were hospitalized for a CV reason, compared with 980 (33.0%) of the placebo subjects (RR 0.92, 95% CI, 0.85\u20130.99; p=0.025).\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EFewer subjects in the telmisartan group tended to discontinue their study medication compared with the placebo group, (639 [21.6%] vs 705 [23.8%]; p=0.055). The most common cause of permanent discontinuation, hypotensive symptoms, occurred in 29 (0.98%) patients in the telmisartan group and 16 (0.54%) in the placebo group (p=0.049).\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe authors concluded, \u201cTelmisartan was well tolerated in patients unable to tolerate ACE inhibitors. Although the drug had no significant effect on the primary outcome of the study, which included hospitalizations for heart failure, it modestly reduced the risk of the composite outcome of cardiovascular death, myocardial infarction, or stroke.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EResults of this study were published simultaneously online in \u003Cem\u003EThe Lancet\u003C\/em\u003E.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/6\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmcs3\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}