The recently presented results of the VALUE trial have emphasized the critical importance of tight blood pressure control to provide greater protection against cardiovascular events.1 The results provide further evidence in support of international hypertension guidelines which recommend the use of long acting agents that provide sustained 24 hour blood pressure control to reduce cardiovascular risk.2,3

The VALUE trial was designed to test the hypothesis that, for the same degree of blood pressure control, valsartan would reduce cardiac morbidity and mortality more than amlodipine in hypertensive patients at high cardiovascular risk. Although the main outcome of cardiovascular events did not differ between the two treatment groups, there were more pronounced reductions in blood pressure in the amlodipine group than in the valsartan group, which translated into significant reductions of MI and stroke.1

These findings underline the importance of reliable and sustained blood pressure control and confirm that aggressive treatment to reach target blood pressure goals is critical to reducing cardiac events.

Telmisartan (Micardis?), an angiotensin II receptor blocker, provides sustained 24 hour control and is consistently superior to other commonly used anti-hypertensives.4

Data from a large database of telmisartan studies using ambulatory blood pressure monitoring (ABPM) show that telmisartan produces significantly greater reductions in mean ambulatory blood pressure in the last 4-6 hours of the dosing interval than the commonly-used antihypertensives valsartan, losartan and amlodipine.4-8

Furthermore, data from recently completed large international studies due to be published imminently confirm that telmisartan (80mg) provides superior blood pressure control compared with valsartan (160 mg) for up to 48 hours after an active dose.9-10 Telmisartan (Micardis?) is currently being investigated in the most ambitious and far-reaching research programme ever conducted with an ARB, with more than 54,000 patients. The ONTARGETTM Trial Programme, the PRoFESS? trial and the PROTECTIONTM trial programme aim to show reduction in cardiovascular morbidity and mortality, secondary stroke prevention and end organ protection.

Whereas VALUE is an anti-hypertensive trial, the forthcoming ONTARGETTM Trial Programme (Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) will answer significant questions around the prevention of cardiovascular disease in a population of more than 31,500 patients who are normotensive or have controlled blood pressure - exploring the effect of combining an ARB (telmisartan) and an ACE inhibitor (ramipril) independently of blood pressure lowering.

The ONTARGETTM Trial Programme is also designed to compare telmisartan to ramipril directly to evaluate whether they provide the same level of cardiovascular protection.

Professor Peter Sleight, Professor Emeritus of Cardiovascular Medicine at the University of Oxford, UK commented: \"VALUE has reinforced that prompt blood pressure lowering is critical to protect against cardiovascular events. It seems likely that the initial dosing regimen of the ARB was, with hindsight, suboptimal.

The different question the ONTARGETTM trial will answer is whether an ARB (telmisartan) and an ACE inhibitor (ramipril), alone or in combination, have cardiovascular protective effects, and whether one class is better than the other, in high risk patients similar to HOPE.

The ONTARGETTM trial will also indicate whether telmisartan may provide additional cardiovascular protection, as in the doses we are using it has shown good blood pressure reduction during the risky early morning period, when the risk of cardiovascular events peaks.\"

Results of the ONTARGET TM Trial Programme are expected to be announced in 2007.

Boehringer Ingelheim

The Boehringer Ingelheim group is one of the world?s 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 152 affiliates in 45 countries and more than 34,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.

In 2003, Boehringer Ingelheim posted net sales of 7.4 billion euro while spending more than one fifth of net sales in its largest business segment Prescription Medicines on research and development.

Telmisartan (Micardis?)

Telmisartan was discovered and developed by Boehringer Ingelheim, Germany. Boehringer Ingelheim markets telmisartan under the trademark Micardis? in 84 countries around the world, including the USA, Japan and major European countries.

Telmisartan is also marketed in some countries by Abbott Laboratories, Bayer AG, GlaxoSmithKline, and Yamanouchi.

Contact:

Boehringer Ingelheim GmbH
Corporate Division Communications
Julia Meyer-Kleinmann
55216 Ingelheim am Rhein
GERMANY
Phone: +49/6132/77 82 71
Fax: +49/6132/77 66 01
References:

1 Julius, Stevo et.al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine; the Value randomised trial, The Lancet 2004; 636:2022-2031

2 2003 European Society of Hypertension ? European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-1053

3 Chobanian AV et al. The Seventh Report of the Joint National Committee (JNC) on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. JAMA 2003; 289(19): 2560-2572.

4 Neutel J et al. Evaluation of ARBs for 24 hour BP control: meta-analysis of a clinical database. J Clin Hypertens 2003;5:58-63

5 Littlejohn T et al. A prospective, randomised, open-label trial comparing telmisartan 80 mg with valsartan 80 mg in patients with mild to moderate hypertension using ambulatory blood pressure monitoring. Can J Cardiol 2000;16:1123-1132

6 Smith D et al. Comparison of telmisartan versus losartan: meta-analysis of titration-to-response studies. Blood Press Monit 2003;8:111-117

7 Neutel J. Use of ambulatory blood pressure monitoring to evaluate the selective angiotensin ll receptor antagonist, telmisartan, and other antihypertensive drugs. Blood Press Monit 2000;5 (suppl 1):S35-S40

8 Lacourci?re Y et al. A comparison of efficacies and duration of action of the angiotensin ll receptor blockers telmisartan and amlodipine. Blood Press Monit 1998;3:295-302

9 Lacourciere Y et al. Sustained antihypertensive activity of telmisartan vs valsartan. Blood Press Monit 2004 In press

10 Lacourciere Y et al. Sustained antihypertensive activity of telmisartan vs valsartan. Poster presented at International Society of Hypertension 2004, Sao Paulo Brazil

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