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ACE inhibitors improve outcomes in patients with or at risk for cardiovascular disease; however, about 20% of patients cannot tolerate these agents. Randomized clinical trials are under way to determine whether angiotensin-receptor blockers are an equivalent — or even superior — alternative to ACE inhibitors.
In this manufacturer-sponsored trial, investigators assessed the effectiveness of telmisartan, an ARB, in patients who are intolerant to ACE inhibitors. After a 3-week run-in period, 5926 such patients who had cardiovascular disease or diabetes with end-organ damage, many of whom were concomitantly taking other proven therapies for their conditions, were randomized to receive telmisartan (80 mg/day) or placebo. The study had a power of …