ONTARGET: ARBs and ACE inhibitors are equal but together they fall

This double blind study published in NEJM compared the ACE inhibitor ramipril, the ARB telmisartan, and the combination of the two drugs in patients with vascular disease or high-risk diabetes.
Conclusions Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit.

There are important lessons from this study. firstly ACE inhibitors are unbeatable in reducing
cardio vascular events in high risk patients. Secondly ARB s are as good as ACE inhibitors but it is an expensive options. Thirdly combining ACE to ARB in patients with arterial disease is risky. Thats a surprise to me.