1. The ONTARGET Trial Reference The ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:15. Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

2. Background Angiotensin-converting enzyme (ACE) inhibitors decrease the chances of death in case of high-risk diabetes without heart failure. This trial was conducted to compare the ACE inhibitors with angiotensin receptor blockers (ARBs) and the combination of both in high-risk diabetes or vascular disease.

3. Aim To evaluate whether the ARB (Telmisartan) was not inferior to the ACE inhibitor (Ramipril) and whether a combination of the two drugs was superior to Ramipril alone as a treatment to prevent vascular events in high-risk patients who had cardiovascular disease or diabetes mellitus but did not have heart failure.

4. Method Study design: Initially conducted as a single-blind trial (in run in period) and continued as a double-blind, randomized, placebo-controlled multicenter parallel trial. Study population: 8576 individual received Ramipril (10 mg/day), 8542 individuals received Telmisartan (80 mg/day) while the rest 8502 received both Ramipril and Telmisartan in combination. End point: Death from myocardial infarction, cardiovascular disease, hospitalization following heart failure or stroke was considered as primary end points.

5. Result The trial revealed following statistics for the primary end points (outcomes). The trial also led to development and observation of certain secondary outcomes such as revascularization, hospitalization for angina, renal impairment, renal failure requiring dialysis. The statistics for these can be enlisted as given below.

8. Conclusion Telmisartan was equivalent to Ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. 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. The combination drug shows more adverse events.