Cardiovascular and cerebrovascular diseases are a major cause of death and disability worldwide; around 7.1 million deaths, as well as two thirds of strokes and one half of ischemic heart disease, are attributable to nonoptimal blood pressure control. Large outcome trials have demonstrated that blockade of the renin-angiotensin system (RAS) is an important approach to the treatment of hypertension as well as to the prevention of cardiovascular events, such as heart failure, myocardial infarction, stroke in patients with metabolic risk factors, and renal disease progression in patients with type 2 diabetes.
Many patients at high cardiovascular risk receive either suboptimal treatment or no treatment. Therefore, identifying patients at high risk for cardiovascular disease is of pivotal importance. A number of tools have been generated to estimate a patient's total cardiovascular risk. Once identified, therapy to reduce the modifiable risk factors, including lifestyle changes and pharmacotherapy, can be initiated as appropriate. However, it is clear that novel treatment approaches are required for these patients, and one approach that holds great potential is dual RAS control with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors.
RAS blockade has been shown to have a beneficial effect on the endothelial and vascular dysfunction that can lead to target organ damage and to both cardiovascular disease and renal disease. Because ARBs and ACE inhibitors differ in their modes of action, combination therapy could provide greater blockade of RAS as well as provide other vascular benefits. It is clear, however, that although some suggestive evidence already exists, clinical proof requires large trials, such as the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) program. The ONTARGET program will test, in patients at high risk for cardiovascular disease, the cardio and vascular protective effects of a combination of an ARB and an ACE inhibitor that has already shown promise in studies of target organ damage and inflammatory markers. The results of ONTARGET will be released on March 31, 2008.
The articles that comprise this supplement were presented at an international symposium held in Madrid, Spain, on May 4-5, 2007, sponsored by Boehringer Ingelheim, and entitled "A New Dawn in Cardio and Vascular Protection. Cardiovascular High-Risk Patients: Treat to Protect." The meeting examined the importance of powerful blood pressure lowering within the context of a modern understanding of the relationship between cardiovascular outcomes, hypertension, its various measures, and other risk factors, particularly the role of RAS and dual RAS control for reducing the progression of cardiovascular disease in patients with and without hypertension. The meeting was endorsed by the European Society of Hypertension and the International Society of Nephrology.
Reviewed By Ramaz Mitaishvili, MD
