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(Hypertension. 2003;41:e4.)
© 2003 American Heart Association, Inc.

Letters to the Editor

More Hype Than HOPE

Christiana Medical Center, Wilmington, Delaware

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

In the recently published Heart Outcomes Prevention Evaluation (HOPE study),¹ treatment with the ACE inhibitor ramipril was reported to reduce cardiovascular morbidity and mortality independent of blood pressure (BP) reduction. High-risk "normotensive" (BP=140/80 mm Hg) patients (n=9541) were randomized to receive either 10 mg of ramipril or placebo in addition to their current medical regimen. They were followed for 4.5 years. The group receiving ramipril had an approximately 35% reduction in cardiovascular events despite no significant reduction in blood pressure. The reported blood pressure reduction was 3 mm Hg systolic and 2 mm Hg diastolic, which was dismissed as insignificant.

The conclusions of this study were that ACE inhibition is beneficial, independent of its antihypertensive effects, and should be initiated in all high-risk patients despite their baseline blood pressure.

In a recently published HOPE substudy,² published in the journal Hypertension, December 2001, the details of the HOPE study protocol are revealed with some surprising revelations. Ramipril was actually dosed in the evening and outpatient blood pressure was measured the following day, on average 10 to 14 hours after dosing. The reported change in blood pressure in the HOPE study (3/2 mm Hg) was a snapshot reading reflecting the trough level and nadir effect of the medication. When the investigators actually looked at the average overnight blood pressure on ambulatory blood pressure monitoring, there was a whopping 17/8 mm Hg reduction in blood pressure during the evening hours. For the entire 24-hour ambulatory blood pressure recording, the . . . [Full Text of this Article]