[Modern tendencies in the treatment of patients with high risk of development of cardiovascular complications and intolerance to angiotensin converting enzyme inhibitors: value of results of TRANSCEND trial for clinical practice].

Clinical value of pharmacologic blockade of renin angiotensin aldosterone system for deceleration of cardiovascular continuum is strongly proved. Up to 20% of population is intolerant to ACE inhibitors. There are no strong evidences that ACE inhibitors differ from angiotensin receptors blockers in influence on main cardiovascular outcomes. In placebo controlled randomized multicentre trial TRANSCEND clinical efficacy, safety and tolerability of telmisartan was studied in elderly patients with high cardiovascular risk who were intolerant to ACE inhibitors. Telmisartan based therapy was associated with decrease of secondary end point (composite of cardiovascular death, myocardial infarction, or stroke) by 13% in comparison with placebo (p=0.048). There were significantly less hospitalizations due to cardiovascular causes in telmisartan group than in placebo group. Risks of new diabetes mellitus, renal dysfunction and serious adverse events were similar in both groups. Combined results of TRANSCEND and PRoFESS trials have demonstrated significant advantage of active telmisartan based therapy concerning the primary outcome of composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure ( 7%, p=0.026).