The Boehringer Ingelheim drug Micardis, or telmisartan, is  typically used in patients with heart failure, but the study  found it worked as well as the ACE inhibitor ramipril, marketed  in the United States as Altace by King Pharmaceuticals Inc.    “We have one more alternative to use,” said Dr. Salim Yusuf  of McMaster University in Ontario, Canada. “This is probably  key for the 20 to 30 percent of people who don’t tolerate an  ACE inhibitor,” said Yusuf, who presented the study at a  meeting of the American College of Cardiology in Chicago. Telmisartan is an angiotensin receptor blocker, or ARB. Ramipril is an angiotensin converting enzyme, or ACE,  inhibitor. Both act on a compound called angiotensin in  different ways to regulate blood pressure. A team of international researchers compared the drugs in a  study of more than 25,620 patients with heart disease or  diabetes and other heart risk factors, but not heart failure. Telmisartan and ramipril alone worked equally well to  reduce cardiovascular death, stroke, heart attack or  hospitalization for heart failure, but telmisartan was easier  to tolerate than ramipril, with fewer patients experiencing  cough or other side effects. Micardis is the first ARB to be shown to have heart  benefits in patients who do not have heart disease. But since  the drug is more costly than the typical ACE inhibitor, the  study may not change practice, doctors said. “The newer drug is certainly not better,” said Dr. Steven  Nissen, a cardiologist from the Cleveland Clinic. “The drugs were equivalent in the trial, which means that  the same results can be achieved with an ACE inhibitor,” Nissen  said in an interview. “I think most physicians will choose the  drugs that are generically available,” he said. The study, published online in the New England Journal of  Medicine, also tested to see if Micardis combined with an ACE  inhibitor might work even better. But the researchers found the  combination caused a number of negative side-effects in  patients who do not have heart failure. Yusuf said the findings mean doctors need to be careful not  to use both drugs in patients. “What was even more important  was adding the two together could cause harm,” he said.
Blood pressure drug Micardis cuts heart risk: study.