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Prescriber Update Articles

Combination use of Angiotensin Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB)

Web site: May 2009
Prescriber Update 2009;30(2):12

The Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) investigated the use of telmisartan (ARB) with ramipril (ACEI)1 (Lancet 2008; 372: 547-53). The use of telmisartan and ramipril did not result in a reduction in cardiovascular events above that seen with each medicine individually, but did result in a higher incidence of adverse renal events, a faster deterioration in renal function parameters, hypotension, diarrhea, and hyperkalaemia.

The applicability of these results to other combinations of ACEIs and ARBs or when used in different indications is not certain. Prescribers are advised only to use an ACEI in combination with an ARB if judged strictly necessary in individual patients and to monitor these patients closely for adverse effects.

Reference

1. Mann JFE, Schmieder RE, McQueen M, et al. Renal outcomes of telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomized, double-blind, controlled trial. Lancet 2008; 372:547-53.