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Document Details : Title: Are ACE-inhibitors or ARB's still needed for cardiovascular prevention in high risk patients? Insights from PRoFESS and TRANSCEND Author(s): VAN MIEGHEM W, BILLIOUW JM, BROHET C, DUPONT AG, GAZAGNES MD, HELLER F, KRZESINSKI JM, MISSAULT L, PERSU A, PIÉRARD L, ROTTIERS R, VANHOOREN G, VERVAET P, HERMAN AG Journal: Acta Clinica Belgica Volume: 65    Issue: 2   Date: 2010    Pages: 107-114 DOI: 10.2143/ACB.65.2.1002394 Abstract : The HOPE and EUROPA clinical studies have shown that treatment with the angiotensinconverting enzyme (ACE) inhibitors, ramipril and perindopril, may reduce the occurrence of major cardiovascular events in patients with proven atherosclerotic disease. The recently published results of the PRoFESS and TRANSCEND trials completed the much needed information concerning the use of an angiotensin receptor blocker for patients at high risk of cardiovascular events. PRoFESS compared a therapy of telmisartan 80 mg daily with placebo in patients with a recent ischemic stroke. The difference in the primary outcome of fi rst recurrent stroke was not statistically significant between telmisartan and placebo. The secondary outcome of major cardiovascular events showed a relative risk reduction (RRR) of 7% in favour of telmisartan. This tended to be significant (p=0.06) despite a rather short follow-up period of only 28 months. In TRANSCEND 5,926 patients at high risk for cardiovascular events were randomized to a treatment with telmisartan 80 mg daily or placebo for a mean duration of follow-up of 56 months. The primary composite outcome of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure showed a non-significant 8% RRR in favour of the telmisartan treated patients. The main secondary outcome of cardiovascular death and myocardial infarction or stroke as used in the HOPE trial showed a non-significant RRR of 13% in favour of telmisartan treated patients (p= 0,068 adjusted for multiplicity of comparisons). In comparing the Kaplan-Meier curves for the endpoint of major cardiovascular events used in HOPE, EUROPA, TRANSCEND and PRoFESS, the trends are similar. Results of most of the recently published trials have been neutral. This could partly be explained by major improvements in the optimal background therapy of the patients included. Nevertheless, the results of PRoFESS and TRANSCEND do not contradict the results from previous studies with the ACE inhibitors ramipril and perindopril and the ARB telmisartan.