Effect of long-term ACE-inhibitor therapy in elderly vascular disease patients.
OBJECTIVE
Cardiovascular (CV) disease is the leading cause of death in the elderly. The use of ACE-inhibitors in elderly patients with chronic stable vascular disease has not been previously reported.


RESULTS
The HOPE trial evaluated the effects of ramipril and vitamin E in high-risk vascular disease patients. We report the effects of ramipril in the elderly HOPE study patients, defined as those > or =70 years of age. A total of 2755 elderly patients with vascular disease or diabetes and at least one additional CV risk factor and without heart failure or low ejection fraction were randomized to ramipril 10 mg daily or placebo. Those assigned to ramipril had fewer major vascular events compared to those assigned to placebo [18.6 vs. 24.0%, hazard ratio (HR) = 0.75, P = 0.0006], CV deaths (9.3 vs. 13.0%, HR = 0.71, P = 0.003), myocardial infarctions (12.0 vs. 15.6%, HR = 0.75, P = 0.006), and strokes (5.4 vs. 7.7%, HR = 0.69, P = 0.013). Treatment was safe and generally well tolerated.


CONCLUSIONS
Ramipril reduces the risk of major vascular events in elderly patients with vascular disease and is safe and well tolerated by most.
Gianni
Monica
M
Department of Medicine, University of Insubria, Varese, Italy.
Bosch
Jackie
J
Pogue
Janice
J
Probstfield
Jeffrey
J
Dagenais
Gilles
G
Yusuf
Salim
S
Lonn
Eva
E
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000627:therapeutic use*; D012307:Risk Factors; D016037:Single-Blind Method; D016896:Treatment Outcome; D028761:Withholding Treatment
D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril