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Study showed ARBs as good as an ACEi

We read with interest one of your items relating to the key findings presented at the ACC conference

This related to the ONTARGET study and implied that outcomes were slightly better in the ramipril arm of the study compared with those treated with telmisartan.

The 0.2% difference in the percentage of patients free from events during the study did not come close to reaching statistical significance. The study had a non-inferiority design and the results enable a confident conclusion that there was non-inferiority between the two treatments.

Interestingly, the patients treated with telmisartan showed fewer adverse effects - particularly in respect of cough and angio-oedema. The 3.8-fold excess prevalence of cough in the ramipril versus telmisartan patients should be seen in the context of a design that excluded patients who developed an ACE inhibitor cough during a run-in period before double-blind randomisation.

We would be grateful if you would bring this to the attention of your readers.

Dr Stephen Jackson, Professor of clinical gerontology,King's College Hospital, London

Dr Terry McCormack, GP, Whitby, North Yorkshire

Professor Stephen Jackson is an ONTARGET investigator. He has also received honoraria for speaking and for consultancy from: Boehringer Ingelheim, Servier, Pfizer and Eisai.

Dr Terry McCormack has received educational and research grants as well as advisory honoraria from Boehringer-Ingelheim, Daichii-Sankyo, Merck Sharp & Dohme, Novartis, Recordati, sanofi aventis, Servier and Takeda.

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