[No advantage of the combination of ACE-inhibition and angiotensin receptor blockade in patients with high cardiovascular risk].

The results of the 'Ongoing telmisartan alone and in combination with ramipril global eendpoint trial' (ONTARGET) have recently been published. In this trial, which was performed in patients with a high cardiovascular risk, it was investigated whether angiotensin II receptor blockade with telmisartan is equally effective as angiotensin converting enzyme (ACE) inhibition with ramipril and whether the combination oftelmisartan and ramipril (dual blockade) is more effective than ACE-inhibition alone to reduce cardiovascular morbidity and mortality and hospitalization for heart failure. On the basis of the ONTARGET results it can be concluded that dual blockade has no place in the treatment of high cardiovascular risk patients without heart failure, because this approach gives no additional reduction of cardiovascular risk and may even be associated with increased mortality. It also has more side effects. Since telmisartan was equally effective and safe as ramipril, one can choose from both agents in the treatment of patients with a high cardiovascular risk.