Are the effects of telmisartan more marked in hypertensive patients?

The Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (TRANSCEND) assessed whether the administration of the AT1 receptor blocker telmisartan, in patients who were intolerant to angiotensin-converting enzyme (ACE) inhibitors, could reduce cardiovascular outcomes or new onset diabetes in high-risk patients [1]. The patients had to be aged 55 years or older, be intolerant of ACE inhibitors, and have established coronary artery disease, peripheral vascular disease or cerebrovascular disease, or diabetes with end organ damage. In the original trial, telmisartan did not reduce the composite primary outcome (cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure: hazard ratio 0.92: P = 0.2) but did reduce the three-fold outcome, omitting heart failure (hazard ratio 0.87: P = 0.048).