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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Effect of long-term ACE-inhibitor therapy in elderly vascular disease patients
Monica Gianni1, Jackie Bosch, Janice Pogue
1Department of Medicine, University of Insubria, Varese, Italy.
European Heart Journal
|March 31, 2007
Summary
Ramipril significantly reduced major vascular events, cardiovascular deaths, heart attacks, and strokes in elderly patients with vascular disease. This angiotensin-converting enzyme inhibitor (ACE-inhibitor) proved safe and well-tolerated in the HOPE trial.
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.
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