ABSTRACT
The use of ACE inhibitors may be extended after the results of the Heart Outcomes Prevention Evaluation Study (HOPE).138,139 A total of 9297 high risk patients over the age of 55 with evidence of vascular disease or diabetes and one other cardiovascular risk factor (hypertension, elevated total cholesterol, low HDL, smoking or microalbuminuria) were randomly assigned to receive 10 mg ramipril or placebo. Use of ramipril resulted in a significant reduction in the primary endpoint, a composite of MI, stroke or death from cardiovascular causes (relative risk 0.78 ramipril vs placebo; p 0.001). The ramipril group also showed significant reductions in MI (9.9:12.3%, relative risk 0.8; p 0.001), stroke (3.4:4.9%, relative risk 0.68; p 0.001), death from cardiovascular causes (6.1:8.2%, relative risk 0.74; p 0.001), and death from any cause (10.4:12.2%, relative risk 0.84; p 0.005), in addition there were reductions in revascularization procedures, cardiac arrest and heart failure. The benefits seen were significantly greater than that expected from blood pressure lowering alone (3/2 mmHg ramipril
other ACE inhibitors and to angiotensin II antagonists is unclear, as is the exact mechanism of the effect witnessed.140
