The HOPE study

(Heart Outcomes Prevention Evaluation trial)

Double-blind, randomized, placebo-

controlled trial
Over 9000 patients at high risk of

cardiovascular disease
4.5-year treatment period Compared the risk of cardiovascular events

with the ACE inhibitor, ramipril (10 mg/day), vs placebo, both given as add-on to existing antihypertensive therapy
N Engl J Med 2000;342:145153.
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HOPE
(Heart Outcomes Prevention Evaluation trial)
Patients 9297,across 27countries but not INDIA

Duration 5years Mean reduction BP was 3/2 mmHg Significant reduction in all major outcome events

e.g., Death(26%),MI(20%),Stroke(32%)

Patients were already on; Beta-blockers(39%) Lipid lowering agent (28%) CCB (46%) Antiplatelet(75%) Diuretics(15%)
Benefits cannot be entirely due to BP reduction.
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HOPE study results primary endpoints

Combined cardiovascular endpoint
Cardiovascular mortality, myocardial infarction, stroke

Cardiovascular mortality

Myocardial infarction

Stroke

-22% p<0.001

-20% p<0.001 -26% p<0.001

Ramipril n=4645, Placebo n=4652

3The

-32% p<0.001

HOPE Study Investigators, 2000

HOPE study results secondary endpoints

All-cause mortality
Need for revascularization
Hospitalization for heart failure

Complications relating to diabetes

-15% p=0.002 -16% p=0.005 Ramipril n=4645, Placebo n=4652 The HOPE Study Investigators, 2000 4

-12% p=0.25

-16% p=0.03