The Journal of Informed Pharmacotherapy 2002;9:152.
Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address: email@example.com
Reviewer's profession/specialty: Professor, Faculty of Pharmaceutical Sciences, UBC
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53 PubMed citation
These investigators evaluated the benefit of treating high risk patients with either ramipril or placebo.
9,297 patients mean age 66 (26% women) with a history of CAD (80%), stroke (11%), peripheral vascular disease (45%), or diabetes (39%) PLUS AT LEAST ONE OF either hypertension (47%), elevated total cholesterol (66%), low HDL (19%), smoker (14%), or documented microalbuminuria (21%) - excluded if they had heart failure - prior to randomization - run in phase - 2-3 weeks - 1035 of 10,576 dropped out due to noncompliance, side effects, abnormal serum creatinine/ potassium or withdrawal of consent.
Ramipril 10 mg PO daily (starting at 2.5mg) or placebo.
|MI, stroke, death from CHD (%)||All deaths (%)||MI (%)||Revascularization (%)||CHF (%)||Strokes (%)|
|Relative Risk Reduction||21||15||20||13||22||31|
|Absolute Risk Reduction||3.8||1.8||2.4||2.3||2.5||1.5|
|NNT/NNH over 5 years||28||56||43||38||40||67|
NNT = numbers needed to treat, NNH = numbers needed to harm
Blood pressure was 3/2 mmHg (2 years) to 2/1 mmHg different at end of trial.
This study shows that treatment of patients with a history of a cardiovascular complication or diabetes plus at least one other risk factor with ramipril reduces the chance of MI, stroke, death from CHD by 3.8%. Whether this benefit is unique to ACE inhibitors versus other antihypertensives or antihyperlipidemics is not clearly known.
Copyright © 2002 by the Journal of Informed Pharmacotherapy. All rights reserved.