BMJ 2002;324:687-688 ( 23 March )

Editorials

Preventing stroke

High risk patients should receive ramipril irrespective of their blood pressure

Papers p 699

The first 150 words of the full text of this article appear below.

The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiotensin converting enzyme inhibitor ramipril on cardiovascular events and disease progression.1 In this issue the investigators describe the results of preventing stroke (p 699).2 The findings clearly show that ramipril substantially decreased the risk of stroke and transient ischaemic attacks in 9297 patients with high cardiovascular risk. A 32% relative risk reduction was found, while the reduction in blood pressure was only 3.8 mm Hg (systolic) and 2.8 mm Hg (diastolic). This benefit was greater than expected from prior meta-analyses of epidemiological studies or trials in hypertension studies. The results have important implications for the primary and secondary prevention of stroke.

Firstly, it must be emphasised that hypertension is still the most important risk factor for stroke, as shown in all studies on hypertension in recent decades,3 and more recently in the PROGRESS study, in which an average blood . . . [Full text of this article]
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This article has been cited by other articles:

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Rapid Responses:

Read all Rapid Responses

Are other classes of drugs effective
john sharvill
bmj.com, 25 Mar 2002 [Full text]
Ramipril in stroke prevention: benefits were considerably overstated
Andrew P Wakeman, et al.
bmj.com, 25 Mar 2002 [Full text]
Tolerance of remipril
pervez Asghar, et al.
bmj.com, 26 Mar 2002 [Full text]
Is there HOPE for 2.5mg?
Peter David Burrill
bmj.com, 26 Mar 2002 [Full text]
There are outcome data on A2As in hypertension
FD Richard Hobbs
bmj.com, 22 May 2002 [Full text]
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