title: Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  Ramipril significantly reduces the rate of development of heart failure in patients at high risk of cardiovascular events.
authors.affiliation: London Health Sciences Centre, London, Canada. malcolm.arnold@lhsc.on.ca
authors.forename: J Malcolm O
authors.initials: JM
authors.lastname: Arnold
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: James
authors.initials: J
authors.lastname: Young
authors.forename: James
authors.initials: J
authors.lastname: Mathew
authors.forename: David
authors.initials: D
authors.lastname: Johnstone
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.forename: Janice
authors.initials: J
authors.lastname: Pogue
authors.forename: Jackie
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000150:complications; D017257:Ramipril / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril