1、糖尿病内分泌内科JournalClub,総合診療感染症科杤谷健太郎,Journal,Telmisartan, Ramipril, or Both in Patients at High Riskfor Vascular Events（The ONTARGET Investigators）N Engl J Med 358;15april 10, 2008,血管高患者ACE-I投与、ARB投与効果比較試験,Background,心不全左室機能不全冠動脈疾患糖尿病合併症持患者ACE-I投与、心筋梗塞脳卒中心不全発症率死亡率低下ACE-I副作用、咳嗽、血管浮腫、服用得多,Method,人randoma
2、zationTelmisartan 80mg/日内服人Ramipril 5mg/日内服人両方内服人平均追跡期間月,Primaryoutcome血管合併症死亡、入院,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,TableBaseline Characteristics of the Patients,Table,糖尿病、OMI、CABG後心血管合併患者割合多,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,TableD
3、iscontinuation of Study Medications and Selected Reasons for Permanent Discontinuation,discontinuation,Ramipril群人Telmisartan群人両方内服群人Telmisartan群低血圧症状、両方内服群低血圧症状、下痢、腎機能異常有意多Telmisartan群咳嗽少,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,FigureKaplan-Meier Curves for the Primary Ou
4、tcome in the Three Study Groups,Results,ramipril群1412人発生（16.5%)Telmisartan群1423人発生（16.7%)発生有意差,Results,副作用咳嗽関telmisartan群優位少（1.1%対4.2%)Angioedema関有意差（0.1%対0.3%)低血圧症状telmisartan群優位多（2.6%対1.7%),Results,両方内服群ramipril群比、低血圧症状（4.8%対1.7%）、失神（0.3%対0.2%）、腎機能異常（13.5%対10.2%）多Primaryoutcome人（16.3%)有意差,The ONTA
5、RGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,FigureRelative Risk of the Primary Outcome and of the Main Secondary Outcome,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,TableIncidence of the Primary Outcome, Its Components, and Death from Any Cause,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,TableSecondary and Other Outcomes,The ONTARGET Investigators. N Engl J Med 2008;10.1056/NEJMoa0801317,Relative Risks in Prespecified Subgroups,Conclusions,血管高患者、ARB投与ACE-I投与比較、新抑制効果同等副作用低血圧症状多、咳嗽、angioedema少、副作用使分可能考,
