Remembering landmark trials of the past - HOPE(2000)

Heart Outcomes Prevention Evaluation(HOPE) published in 2000 was one of the landmark trials in evaluating the efficacy of Ramipril in preventing death in those with known cardiovascular disease and high risk group with diabetes.

Brief summary is as follows:

• A 2 x 2 factorial design which also evaluated the effect of Vitamin E apart from Ramipril
• 9297 patients were included.
• Patients atleast 55 years old were eligible for the study if they had a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes plus at least one other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low high-density lipoprotein cholesterol levels, cigarette smoking, or documented microalbuminuria).
• All patients received 2.5mg ramipril in the run in phase prior to randomisation to look for no compliance and adverse effects.
• Then within a month the ramipril group received 10mg (after 1 month titration from 2.5 mg then 5mg)
• Primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes.

• Secondary outcomes like new onset diabetes, heart failure, revascularisation and complications of diabetes(Nephropathy and retinopathy) also showed significant improvement.


• The benefits with Ramipril were seen in patients who were already on Aspirin, Beta blockers and Statins.


• The reduction in BP was just 3/2 mm Hg and the benefit derived was far beyond this anti hypertensive effect.


• Vitamin E was no more effective than placebo.

Ramipril is an ACEI up our sleeves.

HOPE - Original article - NEJM link here