Use of ramipril in preventing stroke: double blind randomised trial.
OBJECTIVE
To determine the effect of the angiotensin converting enzyme inhibitor ramipril on the secondary prevention of stroke.


METHODS
Randomised controlled trial with 2x2 factorial design.


METHODS
267 hospitals in 19 countries.


METHODS
9297 patients with vascular disease or diabetes plus an additional risk factor, followed for 4.5 years as part of the HOPE study.


METHODS
Stroke (confirmed by computed tomography or magnetic resonance imaging when available), transient ischaemic attack, and cognitive function. Blood pressure was recorded at entry to the study, after 2 years, and at the end of the study.


RESULTS
Reduction in blood pressure was modest (3.8 mm Hg systolic and 2.8 mm Hg diastolic). The relative risk of any stroke was reduced by 32% (156 v 226) in the ramipril group compared with the placebo group, and the relative risk of fatal stroke was reduced by 61% (17 v 44). Benefits were consistent across baseline blood pressures, drugs used, and subgroups defined by the presence or absence of previous stroke, coronary artery disease, peripheral arterial disease, diabetes, or hypertension. Significantly fewer patients on ramipril had cognitive or functional impairment.


CONCLUSIONS
Ramipril reduces the incidence of stroke in patients at high risk, despite a modest reduction in blood pressure.
Bosch
Jackie
J
Canadian Cardiovascular Collaboration, McMaster University, 237 Barton St E, Hamilton, ON, Canada L8L 2X2. jackie@ccc.mcmaster.ca
Yusuf
Salim
S
Pogue
Janice
J
Sleight
Peter
P
Lonn
Eva
E
Rangoonwala
Badrudin
B
Davies
Richard
R
Ostergren
Jan
J
Probstfield
Jeff
J
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008875:Middle Aged; D017257:Ramipril / Q000627:therapeutic use*; D020521:Stroke / Q000517:prevention & control*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D017257:Ramipril