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Original Article

Ambulatory Blood Pressure Values in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET)

Giuseppe Mancia, Gianfranco Parati, Grzegorz Bilo, Peggy Gao, Robert Fagard, Josep Redon, Istvan Czuriga, Martin Polák, Josè M. Ribeiro, Ramiro Sanchez, Bruno Trimarco, Paolo Verdecchia, Walter van Mieghem, Koon Teo, Peter Sleight, Salim Yusuf
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https://doi.org/10.1161/HYPERTENSIONAHA.112.199562
Hypertension. 2012;HYPERTENSIONAHA.112.199562
Originally published October 15, 2012
Giuseppe Mancia
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Gianfranco Parati
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Grzegorz Bilo
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Peggy Gao
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Robert Fagard
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Josep Redon
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Istvan Czuriga
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Martin Polák
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Josè M. Ribeiro
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Ramiro Sanchez
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Bruno Trimarco
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Paolo Verdecchia
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Walter van Mieghem
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Koon Teo
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Peter Sleight
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Salim Yusuf
From the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy (M.G., P.G.); Istituto Auxologico Italiano, Milan, Italy (M.G., P.G., B.G.); Population Health Research Institute, Hamilton, Ontario, Canada (G.P., T.K., Y.S.); University of Leuven, Leuven, Belgium (F.R.); University of Valencia, Valencia, Spain (R.J.); University of Debrecem, Debrecem, Hungary (C.I.); Medeurop, Praha, Czech Republic (P.M.); Department of Cardiology, Felicio Rocho Hospital, Belo Horizonte, Brazil (R.J.M.); Fundacion Favaloro, Hospital Universitario, Buenos Aires, Argentina (S.R.); Università di Napoli Federico II, Napoli, Italia (T.B.); Ospedale di Assisi, Perugia, Italia (V.P.); Ziekenhuis Oost-Limburg, Genk, Belgium (v.M.W.); University of Oxford, Oxford, United Kingdom (S.P.).
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Abstract

In the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial, telmisartan (T; 80 mg daily) and ramipril (R; 10 mg daily) caused similar clinic blood pressure (BP) reductions, with a similar incidence of cardiovascular and renal events. The R+T combination lowered clinic BP somewhat more with no further cardiovascular or renal protection. The aim of this substudy was to see whether these clinic BP changes reflected the changes of 24-hour BP, a BP with a better prognostic value. In 422 patients in whom 24-hour BP monitoring was performed either before or after 6 to 24 months of treatment, demographic and clinical characteristics were similar in the 3 treated groups. Twenty-four-hour systolic BP was similarly reduced by R (−2.0 mm Hg) and T (−2.1 mm Hg), whereas the reduction was more than twice as large in the T+R group (−5.3 mm Hg), which showed a lower on-treatment 24-hour BP also in additional patients (n=408) in whom ambulatory BP was performed only on-treatment. Twenty-four-hour systolic BP was ≈14 mm Hg lower than clinic systolic BP at baseline, whereas during treatment the 2 values became progressively closer as clinic systolic BP was more tightly controlled and superimposable when clinic systolic BP was <120 mm Hg. Similar results were obtained for diastolic BP. These findings provide evidence on the relationship of clinic and ambulatory BP target drug treatment. They also show that in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial, failure of the R+T combination to enhance cardiovascular and renal protection was not because of inability to more effectively control daily life BP.

  • ambulatory blood pressure
  • antihypertensive treatment
  • high cardiovascular risk
  • angiotensin-converting enzyme inhibitors
  • angiotensin receptor blockers
  • Received May 31, 2012.
  • Revision received June 18, 2012.
  • Accepted August 31, 2012.
  • © 2012 American Heart Association, Inc.
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    Ambulatory Blood Pressure Values in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET)
    Giuseppe Mancia, Gianfranco Parati, Grzegorz Bilo, Peggy Gao, Robert Fagard, Josep Redon, Istvan Czuriga, Martin Polák, Josè M. Ribeiro, Ramiro Sanchez, Bruno Trimarco, Paolo Verdecchia, Walter van Mieghem, Koon Teo, Peter Sleight and Salim Yusuf
    Hypertension. 2012;HYPERTENSIONAHA.112.199562, originally published October 15, 2012
    https://doi.org/10.1161/HYPERTENSIONAHA.112.199562

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    Ambulatory Blood Pressure Values in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET)
    Giuseppe Mancia, Gianfranco Parati, Grzegorz Bilo, Peggy Gao, Robert Fagard, Josep Redon, Istvan Czuriga, Martin Polák, Josè M. Ribeiro, Ramiro Sanchez, Bruno Trimarco, Paolo Verdecchia, Walter van Mieghem, Koon Teo, Peter Sleight and Salim Yusuf
    Hypertension. 2012;HYPERTENSIONAHA.112.199562, originally published October 15, 2012
    https://doi.org/10.1161/HYPERTENSIONAHA.112.199562
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