The HOPE Study (Heart Outcomes Prevention Evaluation)
Why the study?
Does ramipril reduce the combined primary endpoint of cardiovascular death, non-fatal MI, and non-fatal stroke in patients at high risk of cardiovascular events?
Population
Patients at high risk of future fatal or non-fatal cardiovascular events, age >55 years, with existing or…
Comparison
Ramipril added to concomitant medication. vs Placebo added to concomitant medication.
Design
Review
Authors
Discussion
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Implication
May support ramipril in high-risk patients; leaves open mechanisms and relevance amid modern therapies.
Key Points
- To evaluate whether angiotensin-converting enzyme inhibition with ramipril reduces cardiovascular morbidity and mortality in high-risk patients with preexisting cardiovascular disease or diabetes.
- Randomized, placebo-controlled trial evaluating ramipril added to standard therapy in patients aged >55 years with established cardiovascular disease or diabetes plus at least one additional cardiovascular risk factor.
- Assessed a designated subgroup of 3,577 diabetic participants to evaluate risk reductions independently of blood pressure changes.
- Ramipril reduced the composite primary endpoint of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke compared to placebo (14% vs. 17.8%; relative risk reduction 22%, p<0.001), prompting early study termination.
- Treatment led to risk reductions of 32% for stroke, 20% for myocardial infarction, 26% for cardiovascular death, and 16% for all-cause mortality, despite a modest blood pressure reduction of only 3–4 mmHg systolic and 1–2 mmHg diastolic.
- In the subgroup of 3,577 diabetic participants, ramipril lowered the primary combined endpoint by 25%, an effect maintained after adjusting for blood pressure reduction in multiple regression analysis.
Structured PICO
Does ramipril reduce the combined primary endpoint of cardiovascular death, non-fatal MI, and non-fatal stroke in patients at high risk of cardiovascular events?
P
Population
Patients at high risk of future fatal or non-fatal cardiovascular events, age >55 years, with existing or previous cardiovascular disease, or diabetes (with at least one other risk factor such as known vascular disease, cigarette smoking, high cholesterol, or hypertension). Includes a diabetic subgroup of n=3577.
I
Intervention
Ramipril (ACE inhibitor) added to concomitant medication (which included antihypertensive drugs, lipid-lowering agents, or aspirin).
C
Comparator
Placebo added to concomitant medication.
O
Outcome
Combined primary endpoint of cardiovascular death, non-fatal myocardial infarct (MI), and non-fatal stroke.composite
Ramipril significantly reduces cardiovascular morbidity and mortality in high-risk patients, including those with diabetes, independent of its modest blood pressure-lowering effects.
Cite This Study
Peter Sleight (2000) studied this question.