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Blockade of the renin–angiotensin system (RAS) has become an integral component of the treatment of patients at increased cardiovascular risk. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) studied 23 400 high-risk cardiovascular patients and compared the effectiveness of telmisartan with that of ramipril and showed that the two drugs were ‘therapeutically equivalent’. Telmisartan is now the only angiotensin II blocker with clinical trial evidence of cardiovascular protection equivalent to that of ramipril, which is widely regarded as the ‘reference’ drug for RAS blockade in patients at increased cardiovascular risk. Despite the prior exclusion of patients intolerant of angiotensin-converting enzyme inhibitors drugs, there were fewer discontinuations in the telmisartan group, and so telmisartan had a superior overall efficacy/tolerability ratio.