HOPE
Trial question
What is the role of ramipril in patients who were at high-risk for CV events but are not known to have a low ejection fraction or HF?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 9297
9297 patients (2480 female, 6817 male).
Inclusion criteria: patients who were at high-risk for CV events but are not known to have a low ejection fraction or HF.
Key exclusion criteria: HF, low ejection fraction (< 0.40), taking ACEI or vitamin E, uncontrolled hypertension or overt nephropathy, or MI or stroke within four weeks before the study.
Interventions
N=4645 ramipril (10 mg once per day PO).
N=4652 placebo (matching placebo PO daily).
Primary outcome
Death, MI, or stroke
14%
17.8%
17.8 %
13.4 %
8.9 %
4.5 %
0.0 %
Ramipril
Placebo
Significant
decrease ▼
NNT = 26
Significant decrease in death, MI, or stroke (14% vs. 17.8%; RR 0.78, 95% CI 0.7 to 0.86).
Secondary outcomes
Significant decrease in CV death (6.1% vs. 8.1%; RR 0.74, 95% CI 0.64 to 0.87).
Significant decrease in death from MI (9.9% vs. 12.3%; RR 0.8, 95% CI 0.7 to 0.9).
Significant decrease in death from stroke (3.4% vs. 4.9%; RR 0.68, 95% CI 0.56 to 0.84).
Conclusion
In patients who were at high-risk for CV events but are not known to have a low ejection fraction or HF, ramipril was superior to placebo with respect to death, MI, or stroke.
Reference
Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Sleight P et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000 Jan 20;342(3):145-53.
Open reference URL