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.

Exclusion Criteria

• •A. Medication use:
• •1. Inability to discontinue Angiotension Converting Enzyme (ACE) inhibitors or Angiotension 2 receptor antagonists (AIIAs).
• •2. Patients with known hypersensitivity or intolerance to Angiotension 2 receptor antagonists (AIIAs) or Angiotension Converting Enzyme (ACE)inhibitors.
• •NOTE: Patients with known intolerance to Angiotension Converting Enzyme inhibitor intolerance ( ACE-I) can be enrolled in the TRANSCEND study.
• •B. Cardiovascular disease:
• •1. Symptomatic congestive heart failure.
• •2. Hemodynamically significant primary valvular or outflow tract obstruction (e.g. aortic or mitral valve stenosis, asymmetric septal hypertrophy, malfunctioning prosthetic valve).
• •3. Constrictive pericarditis.
• •4. Complex congenital heart disease.
• •5. Syncopal episodes of unknown etiology \< 3 months before informed consent.
• •6. Planned cardiac surgery or angioplasty within three months.
• •7. Uncontrolled hypertension on treatment (i.e.Blood pressure ( BP) \> 160/100).
• •8. Heart transplant recipient.
• •9. Strokes due to subarachnoid hemorrhage
• •C. Other conditions:
• •1. Significant renal disease defined as:
• •1. Renal artery stenosis;
• •2. Creatinine clearance \< 0.6 ml/min or serum creatinine \> 265 umol/L (\> 3.0 mg/dL);
• •3. Hyperkalemia: potassium \> 5.5 mmol/L.
• •4. Proteinuria\* (for TRANSCEND only).
• •2. 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.
• •3. Uncorrected volume depletion or sodium depletion.
• •4. Primary aldosteronism.
• •5. Hereditary fructose intolerance.
• •6. Any other major non-cardiac illness expected to reduce life expectancy or interfere with study participation.
• •7. Patient is simultaneously taking another experimental drug.
• •8. Patient with significant disability that precludes regular attendance at clinic for follow-up.
• •9. Patient has sufficient disability or other incapacity that precludes regular attendance at clinic for follow-up.
• •10. Unable or unwilling to provide written informed consent.