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(Hypertension. 2003;41:e5.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Response: HOPE Not HYPE But Mechanisms Can Be Discussed

Departments of Cardiology and Medicine, Karolinska Hospital, Stockholm, Sweden

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

Dr Moutsatsos argues that the BP reduction seen in our substudy on ambulatory BP (ABP) is similar to many hypertension trials. Some of the arguments presented and some of the comparisons made are not correct.

We studied a small subsample that differed from the general HOPE population, most importantly in a higher office BP (OBP) at baseline (151/81 versus 139/79 mm Hg). A greater fall in both OBP (which we found) and ABP during ramipril treatment was thus to be expected in our substudy.

Dr Moutsatsos refers to the magnitude of BP reduction in some trials. Although it is not mentioned, he is referring to reduction of OBP. In doing so, he is comparing our findings of ABP reduction (probably not representative of HOPE overall) with the reduction of OBP in the trials, thus comparing apples and pears since the magnitude of the reduction of ABP in these trials is not known.

HOPE differs in comparison to these BP studies in important aspects. In HOPE, patients were included independent of their OBP levels (up to 160 mm Hg), whereas the hypertension trials included patients with a high OBP.

A bigger difference in OBP vs ABP might be expected in the trials (because patients were selected on OBP). During treatment, a combination of regression toward the mean of OBP as well as greater falls of BP probably affect OBP and ABP differently in the hypertension trials compared with HOPE.

The dosing of ramipril in HOPE (od at bedtime), as well as . . . [Full Text of this Article]