An ACE Inhibitor, an ARB, or Both for Patients at High Vascular Risk?

Angiotensin-converting–enzyme inhibitors lower the incidence of adverse cardiovascular events among people with heart failure, vascular disease, or high-risk diabetes. However, ACE inhibitors do not fully block production of all angiotensin II. In a multinational study, researchers assessed whether an angiotensin-receptor blocker (ARB; telmisartan), alone or in combination with an ACE inhibitor (ramipril), was equivalent or superior to ACE inhibition alone. More than 25,000 patients with vascular disease or high-risk diabetes were randomized to ramipril alone, telmisartan alone, or the combination. The trial was supported by the maker of telmisartan.

After a median follow-up of 56 months, the rate of the primary composite outcome (death from…