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The Warsaw Voice » Other » May 14, 2008
THE WROCŁAW VOICE
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HEALTH: Reducing the Risk
May 14, 2008   
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Krystyna Knypl, M.D., Ph.D., a Polish specialist in internal diseases and treatment for high blood pressure, talks to Barbara Deręgowska.


High blood pressure is a silent killer which is a threat to many people. Is it the only danger that our cardiovascular system has to face?
There are many risk factors that have a negative influence on the heart and cardiovascular system. Hypertension is one of the most common factors, but of course not the only one. Very often it is concomitant with other factors, such as smoking, low physical activity, abdominal obesity, stress and diabetes. When there are many risk factors, their negative influence is seriously intensified. Some of them act in a way difficult to perceive, which leads to a large number of people with a high risk of organ damage.

Cardiovascular disease is the leading cause of death worldwide, causing over 17.5 million deaths per year; 7.6 million people die from a heart attack and 5.7 million die from stroke every year. Global deaths from cardiovascular disease are predicted to reach approximately 25 million by 2020. Cardiovascular disease is also currently a leading cause of disability, and is predicted to be the largest cause of disability worldwide by 2020.

Who is particularly vulnerable to complications? Is there any research being conducted on how to best protect such patients against further complications?
Most vulnerable to complications are people aged over 55, who have had a history of coronary artery disease, stroke or transient ischemic attack, peripheral vascular disease or diabetes mellitus, with internal organ damage. And it is these types of patients who were enrolled on the ONTARGET trial, the results of which were presented on March 31, 2008, at the Annual Scientific Sessions of the American College of Cardiology in Chicago.

The ONTARGET trial consists of two randomized, double-blind, multi-center international trials: the principle trial ONTARGET, just published, and parallel trial TRANSCEND, which will be published later. The treatment arms for the ONTARGET trial were telmisartan 80mg, ramipril 10 mg, and combination therapy with telmisartan 80 mg and ramipril 10 mg. The ONTARGET trial had a four-fold composite endpoint: cardiovascular death, myocardial infarction, stroke and hospitalization for heart failure. Patients intolerant to angiotensin converting enzyme inhibitors (ACE) were not eligible for the ONTARGET study. Intolerance to ACE was a requirement for enrollment into TRANSCEND trial.

Can patients with several factors that have a negative influence on their heart and cardiovascular system be treated effectively? In particular, can they be protected against such complications as heart failure or stroke?
Yes, nowadays we have scientific evidence that such treatment is possible. In 2000, the HOPE trial showed that the cardiovascular risk for patients treated with ramipril was reduced by approximately 20 percent compared with a placebo. This meant that every fifth serious cardiovascular events in the high-risk group of patients was prevented. We know that a similar effect can be attributed to telmisartan. The ONTARGET trial has proven that telmisartan is as protective as the current gold-standard ramipril in reducing the risk of cardiovascular death, myocardial infarction, stroke and heart failure. Moreover, the ONTARGET data shows that telmisartan is associated with higher treatment compliance than ramipril. Besides efficacy, tolerability and compliance are also important factors to consider as they are crucial for effective long-term treatment for prevention of serious cardiovascular events.

ONTARGET also studied the value of combining telmisartan with ramipril, to answer a key question for the clinical community: Does combining an ACE inhibitor and an ARB offer even better protection compared to single blockade? The results indicate that there is no additional protective benefit achieved for the overall patient population, if ramipril and telmisartan are combined.

What is the future then for people who have a high risk of heart and cardiovascular complications?
Using a metaphor, we can say that currently a high-risk patient has the choice of ramipril or telmisartan, both of which act as equally effective protective umbrellas, but telmisartan provides better comfort of use. We now have a new and valuable treatment option for high-risk patients that is effective and better tolerated.
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