Document Detail

Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study.
MedLine Citation:
PMID:  12628949     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous trials in the prevention of heart failure have been restricted to patients with low ejection fraction or hypertension. We assessed an angiotensin-converting enzyme (ACE) inhibitor, ramipril, to prevent the development of heart failure in high-risk patients without known low ejection fraction or heart failure. METHODS AND RESULTS: We randomly assigned 9297 patients to receive double-blind ramipril (10 mg daily) or matching placebo for 4.5 years. Death attributable to heart failure, hospitalization for heart failure, initiation of open-label ACE inhibitor for heart failure, or development of typical signs or symptoms of heart failure developed in 951 patients and was associated with a 4.01-fold increase in the risk of death (P<0.0001). The rate of developing heart failure was significantly increased with coronary disease (risk ratio, 2.17), microalbuminuria (1.82), left ventricular hypertrophy (1.47), increasing age (by decade, 1.37), and diabetes (1.36). Ramipril reduced new-onset heart failure rate from 11.5% to 9.0% (relative risk, 0.77; 95% CI, 0.68 to 0.87; P<0.0001). Ramipril consistently reduced heart failure rate both in those with (relative risk, 0.87) and those without an interim myocardial infarction (relative risk, 0.78). Ramipril also reduced the heart failure rate more in patients with baseline systolic pressure above the median (139 mm Hg) (relative risk, 0.67) compared with those below the median (relative risk, 0.91; P=0.024 for interaction of group by treatment). CONCLUSION: Ramipril significantly reduces the rate of development of heart failure in patients at high risk of cardiovascular events.
J Malcolm O Arnold; Salim Yusuf; James Young; James Mathew; David Johnstone; Alvaro Avezum; Eva Lonn; Janice Pogue; Jackie Bosch;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  107     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-11     Completed Date:  2003-03-24     Revised Date:  2010-04-12    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1284-90     Citation Subset:  AIM; IM    
London Health Sciences Centre, London, Canada.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Cardiovascular Diseases / drug therapy
Double-Blind Method
Follow-Up Studies
Heart Failure / diagnosis,  epidemiology,  prevention & control*
Myocardial Infarction / complications
Ramipril / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 87333-19-5/Ramipril
Comment In:
Circulation. 2003 Mar 11;107(9):1234-6   [PMID:  12628939 ]

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

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