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Effects of an Angiotensin-Converting-Enzyme Inhibitor, Ramipril, on Death from Cardiovascular Causes, Myocardial Infarction, and Stroke in High-Risk Patients
NEJM  January 20, 2000;342:145 - HOPE Study Group.       Editorial  

  • We assessed the role of an angiotensin-converting-enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events but who did not have left ventricular dysfunction or heart failure.
    Methods: A total of 9297 high-risk patients (55 years of age or older) who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low ejection fraction or heart failure were randomly assigned to receive ramipril (10 mg per day orally) or matching placebo for a mean of five years. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes.
    Results: Treatment with ramipril reduced the rates of
    death from cardiovascular causes
    (6.1%, vs 8.1 % in the placebo group; relative risk, 0.75),
    myocardial infarction
    (9.9 percent vs. 12.2 percent; relative risk, 0.80; P<0.001),
    (3.4 percent vs. 4.9 percent; relative risk, 0.69; P<0.001),
    death from any cause
    (10.4 percent vs. 12.2 percent; relative risk, 0.84; P=0.006),
    revascularization procedures (16.0 percent vs. 18.6 percent; relative risk, 0.84; P<0.001),
    cardiac arrest (0.8 percent vs. 1.2 percent; relative risk, 0.63; P=0.03),
    heart failure (7.4 percent vs. 9.4 percent; relative risk, 0.78; P<0.001), and
    complications related to diabetes
    (6.2 percent vs. 7.4 percent; relative risk, 0.84; P=0.03).
    Conclusions:  Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.