HOPE
Heart Outcomes Prevention Evaluation
Paziente / Popolazione Intervento / Esposizione Confronto Esito
In 9,297 high-risk patients with vascular disease or diabetes and preserved LV function, ramipril reduced MI, stroke, or cardiovascular death compared with placebo.
N
9297
Disegno
Multicentre double-blind placebo-controlled RCT, 2×2 factorial
Esito
MI, stroke, or death from cardiovascular causes
Rilevanza
2
RisultatoRamipril 14.0% vs placebo 17.8% (RR 0.78, 95% CI 0.70-0.86, P<0.001), with reductions in CV death (RR 0.74), MI (RR 0.80), stroke (RR 0.68), and all-cause death (RR 0.84).
Yusuf S, et al. N Engl J Med. 2000;342(3):145-53. 10.1056/NEJM200001203420301
Discussione e critica
The modest BP reduction (~3/2 mmHg) arguably too small to explain the benefit, fuelling mechanism debate; companion vitamin E arm neutral. Established ACE inhibitors for vascular protection in high-risk patients without HF or low EF.