Dr haak geisinger trial#
Dr haak geisinger license#

11,12 As compared with beta-blockers, ARBs also reduced vascular events in high-risk patients with hypertension and left ventricular hypertrophy. 9 The use of an angiotensin-receptor blocker (ARB), as compared with placebo, reduced the rate of death or hospitalization for heart failure in patients with a low ejection fraction and heart failure who either could not tolerate an ACE inhibitor 10 or were already receiving one. In patients with heart failure, angiotensin II levels may increase and symptoms worsen, despite the use of ACE inhibitors. ACE inhibitors reduce bradykinin degradation, which enhances vasodilatation, but increase the rates of angioedema and cough. 8 ACE inhibitors do not block the production of all angiotensin II, so direct receptor blockade might be more effective. Randomized, controlled trials involving about 150,000 patients have convincingly demonstrated that angiotensin-converting–enzyme (ACE) inhibitors reduce rates of death, myocardial infarction, stroke, and heart failure among patients with heart failure, 1 left ventricular dysfunction, 2-4 previous vascular disease alone, 5-7 or high-risk diabetes. The combination of the two drugs was associated with more adverse events without an increase in benefit.

Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. In the combination-therapy group, the primary outcome occurred in 1386 patients (16.3% relative risk, 0.99 95% CI, 0.92 to 1.07) as compared with the ramipril group, there was an increased risk of hypotensive symptoms (4.8% vs. 1.7%, P<0.001) the rate of syncope was the same in the two groups (0.2%). 0.3%, P=0.01) and a higher rate of hypotensive symptoms (2.6% vs. As compared with the ramipril group, the telmisartan group had lower rates of cough (1.1% vs. 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, 0.94 to 1.09). 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. The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. MethodsĪfter 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). 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. 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. The most trusted, influential source of new medical knowledge and clinical best practices in the world.

Dr haak geisinger license#

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Dr haak geisinger trial#

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