The HOPE (Heart Outcomes Prevention Evaluation) Study and its Consequences

Abstract

The HOPE study was a 19 country, prospective randomized trial in which the ACE‐inhibitor Ramipril but not Vitamin E significantly reduced the risk of future cardiovascular events in a high‐risk population of men and women, including many with diabetes. The benefits were present in all sub‐groups, independent of the presence or absence of diabetes, hypertension, evidence of cardiovascular disease, microalbuminuria, blood pressure lowering, the use of aspirin, lipid‐lowering or antihypertensive medication. It provided clear evidence that Ramipril should safely and cost‐effectively be used in individuals not known to have low ventricular ejection fraction or heart failure but at high‐risk of cardiovascular events. It was also beneficial in patients with renal insufficiency, reducing progression of proteinuria and development of new microalbuminuria. It provided micro‐ and macrovascular benefits in people with diabetes, reduced the development of new cases of diabetes and showed a positive and graded association between the waist‐to‐hip ratio and the risk of developing diabetes. Sub‐studies completed and on‐going into the predictive role of natriuretic peptides, infectious and inflammatory markers, provide insight into possible mechanisms of action of Ramipril.