Effectiveness and Safety of Ramipril Alone Compared With Telmisartan Alone and in Combination With Ramipril in Patients at High Risk for Cardiovascular Events. Patients Intolerant to Ramipril Were Entered in TRANSCEND, Telmisartan Compared to Placebo.

Inclusion Criteria

Coronary Artery Disease: Previous Myocardial infarction(> 2 days prior to informed consent), or stable or previous unstable angina (> 30 days prior to informed consent) with documented multivessel coronary artery disease or a positive stress test, or multivessel Percutaneous Transluminal Coronary Angioplasty (> 30 days prior to informed consent), or previous multivessel Coronary Artery Bypass Grafting without angina (if surgery performed > 4 years prior to informed consent) or with recurrent angina after surgery.

Other High Risk:

• Peripheral Arterial Disease: Previous limb bypass surgery or angioplasty or amputation, intermittent claudication on history with ankle/arm Blood Pressure ratio 7 days and 160/100).
• Heart transplant recipient.
• Strokes due to subarachnoid hemorrhage

C. Other conditions:

• Significant renal disease defined as:
• Renal artery stenosis;
• Creatinine clearance 265 umol/L (> 3.0 mg/dL);
• Hyperkalemia: potassium > 5.5 mmol/L.
• Proteinuria* (for TRANSCEND only).
• Hepatic dysfunction as defined by the following laboratory parameters: Serum Glutamate Pyruvate Transaminase( SGPT) Alaninaminotransferase (ALT) or Serum Glutamic Oxaloacetic Transaminase (SGOT) Aspartate aminotransferase (AST) > than 4 times upper limit of normal or additional criteria for hepatic impairment the upper limit of normal range, total Bilirubin > 20 umol/L, biliary obstructive disorders.
• Uncorrected volume depletion or sodium depletion.
• Primary aldosteronism.
• Hereditary fructose intolerance.
• Any other major non-cardiac illness expected to reduce life expectancy or interfere with study participation.
• Patient is simultaneously taking another experimental drug.
• Patient with significant disability that precludes regular attendance at clinic for follow-up.
• Patient has sufficient disability or other incapacity that precludes regular attendance at clinic for follow-up.
• Unable or unwilling to provide written informed consent.