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[The HOPE Study. What does it contribute to general practice?].
MMW Fortschritte Der Medizin
|January 6, 2001
Summary
The HOPE study found that ramipril, an ACE inhibitor, significantly reduced cardiovascular events like heart attacks and strokes in high-risk patients. These benefits, including cardio- and nephroprotection, were observed even without substantial blood pressure reduction.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- High cardiovascular risk necessitates effective preventative strategies.
- The Renin-Angiotensin System (RAS) plays a crucial role in cardiovascular regulation.
- Angiotensin-Converting Enzyme (ACE) inhibitors are a class of drugs targeting the RAS.
Purpose of the Study:
- To investigate if inhibiting the RAS with ramipril prevents cardiovascular events in high-risk individuals.
- To evaluate the efficacy of ramipril in reducing myocardial infarction, stroke, and cardiovascular death.
Main Methods:
- The Heart Outcomes Prevention Evaluation (HOPE) study was a double-blind, placebo-controlled trial.
- Participants were patients with high cardiovascular risk.
- The primary endpoint combined myocardial infarction, stroke, and cardiovascular death.
Main Results:
- Ramipril significantly reduced myocardial infarction rates (9.9% vs. 12.2%) and cardiovascular deaths (6.1% vs. 8.1%).
- Strokes (3.4% vs. 4.9%) and revascularizations (16.0% vs. 18.6%) were also significantly decreased.
- A notable increase in cough rate (5%) was observed with ramipril.
- Benefits were largely independent of blood pressure reduction and particularly pronounced in type 2 diabetics.
Conclusions:
- Ramipril effectively prevents major cardiovascular events in high-risk patients.
- Cardio- and nephroprotective effects are significant, especially for type 2 diabetics.
- Albuminuria is a marker for cardiovascular event risk.