Document Detail


Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy.
MedLine Citation:
PMID:  11751742     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the HOPE-trial, the ACE inhibitor ramipril significantly reduced cardiovascular morbidity and mortality in patients at high risk for cardiovascular events. The benefit could only partly be attributed to the modest mean reduction of office blood pressure (OBP) during the study period (3/2 mm Hg). However, because according to the HOPE protocol ramipril was given once daily at bedtime and blood pressure was measured during the day, the 24-hour reduction of blood pressure may be underestimated based on OBP. Thirty-eight patients with peripheral arterial disease enrolled in the HOPE study underwent 24-hour ambulatory blood pressure (ABP) measurement before randomization and after 1 year. OBP was measured in the sitting position immediately before fitting the ABP measuring equipment to the patients. Ramipril did not significantly reduce OBP (8/2 mm Hg, P=NS) or day ABP (6/2 mm Hg, P=NS) after 1 year. Twenty-four-hour ABP was significantly reduced (10/4 mm Hg, P=0.03), mainly because of a more pronounced blood pressure lowering effect during nighttime (17/8 mm Hg, P<0.001). The night/day ratio was also significantly lowered in the ramipril group. ABP shows greater falls, especially at night, than OBP during treatment with ramipril given once daily at bedtime. Although, OBP is the correct comparator when comparing with previous large intervention trials and epidemiological studies, the effects on cardiovascular morbidity and mortality seen with ramipril in the HOPE study may, to a larger extent than previously ascribed, relate to effects on blood pressure patterns over the 24-hour period.
Authors:
P Svensson; U de Faire; P Sleight; S Yusuf; J Ostergren
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Hypertension     Volume:  38     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-12-25     Completed Date:  2002-02-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E28-32     Citation Subset:  IM    
Affiliation:
Department of Medicine Karolinska Hospital, Stockholm, Sweden. persv@divmed.ks.se
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Blood Pressure Monitoring, Ambulatory
Cardiovascular Diseases / etiology,  prevention & control
Circadian Rhythm
Female
Humans
Hypertension / diagnosis,  drug therapy*,  etiology,  physiopathology*
Male
Peripheral Vascular Diseases / complications*
Ramipril / administration & dosage*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 87333-19-5/Ramipril
Comments/Corrections
Comment In:
Hypertension. 2003 Apr;41(4):e4; author reply e5   [PMID:  12623866 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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