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HOPE
About the Trial
The Heart Outcomes Prevention Evaluation trial randomized 9,297 patients with vascular disease or diabetes plus one risk factor to ramipril or placebo. Ramipril reduced cardiovascular death by 26 percent, heart attacks by 20 percent, strokes by 32 percent, and new diabetes by 34 percent. The microalbuminuria substudy identified a graded risk marker. HOPE expanded ACE inhibitor use beyond hypertension and heart failure to broad vascular protection, the vascular biology rationale. Its factorial vitamin E arm, later extended as HOPE-TOO, showed no benefit and tempered antioxidant enthusiasm. Ramipril became one of the most evidence supported drugs in cardiovascular prevention.
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