ABSTRACT
The trial was stopped prematurely, before 5 years, because of a clear advantage in the treated group of patients, who showed a 22% reduction in the primary endpoint (p 0.001). There were comparable reductions in the component endpoints and, unexpectedly, a one-third reduction in the number of new diabetic patients. Benefits of treatment were clear in all sub-groups, including those with pre-existing diabetes. The blood pressure reduction, of 3/2 mmHg, was considered too small to account for the observed benefit. On the basis of these findings it has been estimated that treatment with ramipril prevented nearly 130 events per 1000 patients over 4-5 years in about 60 patients. This analysis is on an intention-to-treat basis and may therefore underestimate actual benefit. The implications of the study for clinical practice are still not finally determined, although among the HOPE investigators there is certainly support for the much more widespread use of ACE inhibitors.48 Importantly, this study reinforces the case for the use of ACE inhibitors in diabetic patients who are not hypertensive.49
