ACE Inhibitors in Cardiovascular Disease — Unbeatable?

The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET, NCT00153101), reported by Yusuf et al.¹ in this issue of the Journal, has important lessons for clinical practice and also illustrates the complexities of designing, conducting, analyzing, and interpreting trials comparing new treatments that act in a manner similar to that of established therapies. As the fourth and largest comparative trial, the ONTARGET study confirms, beyond doubt, that angiotensin-receptor blockers (ARBs) are not better than angiotensin-converting–enzyme (ACE) inhibitors at reducing fatal and nonfatal cardiovascular events. Of course, physicians and patients might still choose to use an ARB . . .