The Heart Outcomes Prevention Evaluation (HOPE) Study: Limitations and Strengths

Domenic A. Sica, MD; Division of Clinical Pharmacology and Hypertension, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.

In This Article

Implications of the Hope Study

The HOPE results show substantial benefits in mortality and morbidity with the use of ramipril in a large group of subjects at high risk of future cardiovascular events.[24,25] The results of the HOPE study were of sufficient significance to prompt the American Heart Association to include this study in its top ten list of research advances for the year 1999. In addition, in early October of this year, the Food and Drug Administration allowed a labeling change for ramipril to incorporate the findings of the HOPE study.

The results of this study were achieved in the context of concurrent conventional treatment and are therefore broadly applicable to clinical practice. The implications for diabetic patients are particularly striking. These results should extend the use of ACE inhibitors to a wider group of patients. ACE inhibitor therapy has previously been proven to be of benefit to those with left ventricular dysfunction, hypertension, and diabetes with proteinuria. ACE inhibitor use can now be extended to a different patient group: those at risk for vascular events but without substantive evidence of left ventricular dysfunction, many of whom are receiving aspirin prophylaxis. Finally, the HOPE study findings provide the factual underpinnings for conducting additional studies, employing different pharmacologic approaches to interruption of the RAS in at-risk patients. The HOPE study was not designed to determine whether ACE inhibitors are the optimal agents for preventing cardiovascular events in high-risk hypertensive patients. This issue is being addressed in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial, in which patients with hypertension and at least one additional risk factor are currently randomized to either an ACE inhibitor, a calcium channel blocker, or a thiazide diuretic.