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PPOGRESS beyond HOPE and LIFE: The ONTARGET trial programme

P. Sleight*

John Radcliffe Hospital, Oxford, U.K.

* Peter Sleight, MD, FRCP, FACC, Professor Emeritus of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, U.K..

Abstract

Large-scale cardiovascular trials traditionally have targeted clinical hypertension, diabetes or survivors of myocardial infarction, but the recent trend in such trials has been to consider the treatment of high-risk individuals rather than specific diseases. This allows the use of a much broader screening process to enrol patients. Angiotensin-converting enzyme inhibitors and angiotensin II receptor block ers (ARBs) act directly on the renin-angiotensin system to effect blood pressure control. The Heart Outcomes Prevention Evaluation (HOPE) and the Perindopril pROtection against REcurrent Stroke Study (PROGRESS) showed that angiotensin-converting enzyme inhibitors (ramipril and perindopril plus the diuretic indapamide), significantly decreased the risk for stroke and other adverse cardiovascular outcomes. Both studies showed benefits in patients with conventionally normal blood pressure. The Losartan Intervention For Endpoint reduction in hypertension (LIFE) trial showed that losartan, an ARB, could also significantly decrease the risk of stroke to an extent greater than that predicted by the decrease in blood pressure. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) Trial Programme is currently underway to study the effect of ramipril and the ARB telmisartan, and a combination of the two agents in patients at high risk of cardiovascular disease.

Key Words: Angiotensin-converting enzyme inhibitors • Angiotensin II receptor blockers • Blood pressure • Cardiovascular risk • Clinical trials • Ramipril Telmisartan

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