ONTARGET^®

ONgoing Telmisartan Alone in combination with Ramipril Global Endpoint Trial

The ONTARGET^® Trial Programme: The largest cardiovascular outcome trial ever undertaken with an angiotensin II receptor blocker

Why conduct this study?

Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality worldwide. Almost 17.5 million deaths per year are attributed to cardiovascular disease (CVD), and these figures are estimated to approach 25 million by 2020. Several risk factors contribute to the onset of cardiovascular disease, including hypertension and diabetes.^1-4

Angiotensin II, a component of the renin-angiotensin system (RAS) involved in blood pressure control, plays a prominent role early on in the chain of events that lead to CVD. In view of this, the search for cardioprotective treatments has expanded to focus on antihypertensive agents targeting the RAS.

The Heart Outcomes Prevention (HOPE) trial was the first clinical trial to demonstrate that high-dose ACE-inhibitor therapy with ramipril leads to a highly significant reduction in CV morbidity and mortality in high-risk patients.^5,6

Thus, suppression of the RAS was associated with favourable CV outcomes in the HOPE study. However, long-term ACE inhibition has been shown to activate angiotensin II production via alternative pathways and result in a rise in angiotensin II levels (the angiotensin II escape phenomenon). This may also attenuate the protective effect of ACE inhibition during long-term therapy.

Blockade of angiotensin II action at the level of the AT₁ receptor may be more efficient than ACE inhibition. Furthermore, to suppress fully the angiotensin II effect and to sustain the inhibition of bradykinin inactivation, the combined application of an ARB and an ACE inhibitor holds significant potential. Click here to read about the mechanism of action of MICARDIS^®.

ONTARGET^® is part of The ONTARGET^® Trial Programme, which comprises two parallel studies, the other trial being TRANSCEND^®.^7,8 The aim of these studies was to assess the effect of MICARDIS^®, ramipril, and their combination on cardiovascular morbidity and mortality.

Together, these two trials form the largest cardiovascular outcome clinical trial programme undertaken to investigate the role of and ARB and an ACE inhibitor alone or in combination in the prevention of stroke, myocardial infarction, cardiovascular death and hospitalization for CHF. The primary endpoint for these studies is similar to that of the HOPE trial.⁹

Learn more about ONTARGET^® via The ONTARGET^® Trial Programme website.

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