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The second study (study B) involved 415 patients randomly assigned to receive captopril 25 mg twice daily plus HCTZ 25 mg twice daily, captopril 50 mg twice daily plus HCTZ 25 mg twice daily, captopril 50 mg twice daily plus placebo, HCTZ 25 mg twice daily plus placebo, or placebo alone for 6 weeks.

Although this finding was not causally shown, it may be legitimate to advise individuals with type 2 diabetes and vascular disease to adhere to a healthy diet avoiding extremes of protein and salt intake to reduce their high risk for renal disease and death.

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ACE inhibitors have been convincingly shown to reduce rates of death, myocardial infarction, stroke, heart failure, and revascularization among patients with previous cardiovascular disease and high-risk diabetes.

Multiple oral doses of Ramipril of 2 mg or more cause plasma ACE activity to fall by more than 90% 4 hours after dosing, with over 80% inhibition of ACE activity remaining 24 hours after dosing.

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As compared with the ramipril group, the telmisartan group had significantly fewer episodes of cough or angioedema, but this benefit was partially offset by higher rates of hypotensive symptoms (but not syncope).

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Owing to a lower than expected incidence of the primary end point, the steering committee decided in September 1997 to extend the follow up to up to six years and to increase the recruitment (in accordance with the recommendations of the independent data and safety committee).

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