[The HOPE Study. What does it contribute to general practice?]

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J Mann1, P Sleight

  • 1Klinikum Schwabing, München. tbno2ab@mail.lrz-muenchen.de

MMW Fortschritte Der Medizin
|January 6, 2001
PubMed

Insights

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.

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