http://www.theheart.org/web_slides/1145327.do A trial on Telmisartan Randomized Assessment Study in ACE-Intolerant Subjects With Cardiovascular Disease (TRANSCEND)

1. TRANSCEND (Telmisartan Randomized
Assessment Study in ACE-Intolerant
Subjects With Cardiovascular Disease)

2. TRANSCEND (Telmisartan Randomized Assessment Study
in ACE-Intolerant Subjects With Cardiovascular Disease)
KK Teo (McMaster University, Hamilton, ON)
European Society of Cardiology 2008 Congress
• Background:
While it is well established that ACE inhibitors reduce mortality, MI, stroke,
and HF in patients with CV disease or high-risk diabetes, the role of
angiotensin-receptor blockers (ARBs) in primary or secondary prevention
in these patients remains unclear
• Population and treatment:
5926 patients with CV disease or high-risk diabetes without HF who were
intolerant to ACE inhibitors
Randomized to telmisartan 80 mg per day (n=2954) or placebo (n=2972)
in addition to other usual therapies
• Primary outcome:
CV death, MI, stroke, or admission to the hospital for HF events

3. TRANSCEND: Results
• Patients on telmisartan had, on average, a 4-mm-Hg reduction in BP compared
with those on placebo
• There was no difference in the incidence of the primary end point with
telmisartan vs placebo: 15.7% and 17.0% (HR 0.92; p=0.216) for telmisartan
and placebo, respectively
• There was a difference in the prespecified composite secondary outcome of CV
death, MI, and stroke: 13.0% and 14.8% (HR 0.87; p=0.048) for telmisartan and
placebo, respectively—this difference became nonsignificant after statistical
adjustments were made for multiple comparisons (p=0.068)

4. TRANSCEND: Commentary*
"How [can] telmisartan . . . be noninferior to ramipril [based on ONTARGET] but
barely better than placebo? [The findings] illustrate the complexity of interpreting
different patient populations and trying to come up with a conclusion."
- Dr Karl Swedberg
"This shows that if you have good background treatment, the ARB effect is not as
good as we have seen in the earlier studies. The ACE inhibitors should be what we
use first. . . . The whole issue of ARBs or even ACE inhibitors in people who
haven't got other indications such as hypertension or diabetes has to be brought
into question."
- Dr Phil Aylward
*All comments from ARBs unable to TRANSCEND placebo in high-risk patients
(http://www.theheart.org/article/899035.do)

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