HOPE sub-study backs up ramipril benefit

A sub-study of the landmark HOPE study, which last year found thattreatment with Aventis/King Pharmaceuticals' ramipril significantly reduced the risk of myocardial infarction, stroke, heart failure and death from cardiovascular causes in high-risk patients, has shown that the ACE inhibitor can slow down the progression of atherosclerotic plaques in arteries.

SECURE (Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E) included 732 patients aged 55 or older who had vascular disease or diabetes, and at least one other cardiovascular risk factor, but who did not have heart failure or a low left-ventricular ejection fraction. Patients were randomly assigned to receive either ramipril 2.5mg/day or 10mg/day, vitamin E 400 IU/day or placebo, and atherosclerosis progression was measured by ultrasound assessment of the thickness of the wall of the carotid arteries.

Significant benefits on carotid artery diameter were seen in patients who took the 10mg dose of ramipril in addition to other medications, including aspirin, lipid-lowering agents, beta blockers, nitrates and calcium-channel blockers. Furthermore, the effect of ramipril remained statistically-significant after adjusting for a history of hypertension and blood-pressure changes and was also seen in normotensive subjects.