The Heart Outcomes Prevention Evaluation (HOPE) study has been published in both the New England Journal of Medicine (2000;342:145) and the Lancet (2000;355:253). The study results, which show that the ACE inhibitor ramipril reduces the likelihood of cardiovascular events in high-risk patients by 22 per cent, were first made available on the NEJM website (www.nejm.org) last November “because of the potential therapeutic implications” (PJ 1999;263:338 and 811).
In an accompanying editorial on the trial (Lancet 2000;355:246), Dr Nish Chaturvedi (department of medicine, University College, London) says: “The HOPE findings have considerable implications for clinical practice, since they indicate that virtually all patients with a history of cardiovascular disease, not just those who have had an acute myocardial infarction or who have had heart failure, may now benefit from ACE inhibition.” With regard to an analysis of a sub-group of patients with diabetes, Dr Chaturvedi describes the results as reflecting those from the main study, with a risk reduction of 25 per cent for the composite cardiovascular endpoint.
Questions that remain unanswered by the trial, he says, include whether ACE inhibitors should be recommended as well as, or instead of, “conventional” drugs for hypertension. In addition, while it is now certain that most patients with diabetes should be on some form of antihypertensive therapy, it is still unclear what the choice of agent should be, he says. Dr Chaturvedi concludes that the results of HOPE seem “more novel and easier to assess” for patients with cardiovascular disease than they do for patients with diabetes. He calls for further work on the impact of antihypertensive therapy on patients with diabetes who have no evidence of heart disease.