6/28/23, 11:04 PM HOPE Pathway Feedback Search Clinical Topics Home Studies HOPE HOPE Disease Disease Disease Acute ischemic stroke Coronary artery disease Diabete Trial question What is the role of ramipril in patients who were at high-risk for cardiovascular events but are not known to have a low ejection fraction or HF? Study design Multi-center Double blinded RCT Population Characteristics of study participants 27.0% female N = 9297 73.0% male 9297 patients (2480 female, 6817 male) Inclusion criteria: patients who were at high-risk for cardiovascular events but are not known to have a low ejection fraction or HF Key exclusion criteria: HF, low ejection fraction (< 0.40), taking angiotensin-converting-enzyme inhibitor or vitamin E, uncontrolled hypertension or overt nephropathy, or myocardial infarction or stroke within four weeks before the study Interventions N=4645 ramipril (10 mg once per day PO) N=4652 placebo (matching placebo PO daily) Primary outcome Death, myocardial infarction, or stroke 17.8 % 17.8 https://web.pathway.md/studies/recS8JjaWx0r4ueeF 1/2 6/28/23, 11:04 PM HOPE Pathway 14 13.4 % 8.9 % Significant decrease 4.5 % NNT = 26 0.0 % Ramipril Placebo Significant decrease in death, myocardial infarction, or stroke (14% vs. 17.8%; RR 0.78, 95% CI 0.7 to 0.86) Secondary outcomes Significant decrease in cardiovascular death (6.1% vs. 8.1%; RR 0.74, 95% CI 0.64 to 0.87) Significant decrease in death from myocardial infarction (9.9% vs. 12.3%; RR 0.8, 95% CI 0.7 to 0.9) Significant decrease in death from stroke (3.4% vs. 4.9%; RR 0.68, 95% CI 0.56 to 0.84) Conclusion In patients who were at high-risk for cardiovascular events but are not known to have a low ejection fraction or HF, ramipril was superior to placebo with respect to death, myocardial infarction, or stroke. Reference Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Sleight P et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000 Jan 20;342(3):145-53. Open reference URL https://web.pathway.md/studies/recS8JjaWx0r4ueeF 2/2