Effect of long-term ACE-inhibitor therapy in elderly vascular disease patients

Area of Science:

• Cardiology
• Geriatrics
• Pharmacology

Background:

• Cardiovascular disease is the primary cause of mortality in older adults.
• The efficacy of ACE-inhibitors in elderly individuals with chronic stable vascular disease was previously unreported.

Purpose of the Study:

• To evaluate the effects of ramipril, an ACE-inhibitor, on cardiovascular outcomes in elderly patients.
• To assess the safety and tolerability of ramipril in this demographic.

Main Methods:

• The HOPE trial enrolled 2755 elderly patients (≥70 years) with vascular disease or diabetes and additional cardiovascular risk factors.
• Participants were randomized to receive either ramipril 10 mg daily or a placebo.
• Exclusion criteria included heart failure or low ejection fraction.

Main Results:

• Ramipril significantly decreased major vascular events (18.6% vs. 24.0%), cardiovascular deaths (9.3% vs. 13.0%), myocardial infarctions (12.0% vs. 15.6%), and strokes (5.4% vs. 7.7%) compared to placebo.
• Hazard ratios favored ramipril, with P-values < 0.013 for all major outcomes.
• Ramipril treatment was generally safe and well-tolerated.

Conclusions:

• Ramipril effectively reduces the risk of major vascular events in elderly patients with established vascular disease.
• The medication is safe and well-tolerated in the majority of elderly patients.
• Findings support the use of ramipril in this high-risk population.