Effect of Telmisartan on Renal Outcomes

  1. Johannes F.E. Mann, MD;
  2. Roland E. Schmieder, MD;
  3. Leanne Dyal, MSc;
  4. Matthew J. McQueen, MD;
  5. Helmut Schumacher, MD;
  6. Janice Pogue, PhD;
  7. Xingyu Wang, PhD;
  8. Jeffrey L. Probstfield, MD;
  9. Alvaro Avezum, MD, PhD;
  10. Ernesto Cardona-Munoz, PhD;
  11. Gilles R. Dagenais, MD;
  12. Rafael Diaz, MD;
  13. George Fodor, MD, PhD;
  14. Jean M. Maillon, MD;
  15. Lars Rydén, MD;
  16. Cheuk M. Yu, MD;
  17. Koon K. Teo, MD;
  18. Salim Yusuf, DPh, MD; and
  19. for the TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators
  1. From Schwabing General Hospital and KfH Kidney Center, Ludwig Maximilians University, Munich, Germany; Friedrich Alexander University, Erlangen, Germany; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Boehringer Ingelheim, Ingelheim, Germany; Beijing Hypertension League Institute, Beijing, China; University of Washington, Seattle, Washington; Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; University of Guadalajara, Guadalajara, Mexico; Institute of Cardiology and Pneumology, Laval University and Hospital, Quebec, Quebec, Canada; University of Buenos Aires, Buenos Aires, Argentina; Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; University of Grenoble, Grenoble, France; Karolinska Institutet, Stockholm, Sweden; and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
    1. Figure 1.
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      Figure 1. Study flow diagram.

      All participants received randomized therapy and were followed, except for 18 (0.3%) who were followed until the end of the study or until a primary event occurred. The number of patients considered for the trial who did not enter the run-in phase is unknown. A figure showing trial follow-up and cardiovascular outcomes is published elsewhere (1). Progression of proteinuria was defined as new microalbuminuria, macroalbuminuria, or both. eGFR = estimated glomerular filtration rate; UACR = urinary albumin–creatinine ratio.

    2. Figure 2.
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      Figure 2. Kaplan–Meier curves for the composite renal outcome (dialysis or doubling of serum creatinine).

      There were no significant differences between groups (see Table 1 for details). HR = hazard ratio.

    3. Appendix Figure 1.
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      Appendix Figure 1. Change in estimated GFR from baseline to 6 weeks after randomization, by quartile of change in systolic blood pressure from baseline to 6 weeks.

      Regression analysis demonstrated that a change in systolic blood pressure of 10 mm Hg is associated with a change in estimated GFR of 2.05 mL/min per 1.73 m2. GFR = glomerular filtration rate.

    4. Figure 3.
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      Figure 3. Relative risk for the composite renal outcome (dialysis or doubling of serum creatinine) in subgroups.

      Some 95% CIs exceed the scale of relative risk and are shown by the numbers in parentheses. P values for interaction test whether there is an interaction of the respective subgroup with the 2 treatment methods. Diabetes is defined as having a history of diabetes or a fasting glucose level >7 mmol/L (>126 mg/dL). eGFR = estimated glomerular filtration rate; UACR = urinary albumin–creatinine ratio.

    5. Appendix Figure 2.
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      Appendix Figure 2. Kaplan–Meier curves for the composite renal outcome (dialysis or doubling of serum creatinine), by baseline UACR.

      The treatment–subgroup interaction term was significant (P = 0.006). See Appendix Figure 1. UACR = urinary albumin–creatinine ratio.

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