Ramipril (
Altace)Use of tradenames is for product identification purposes only and does not imply endorsement.), an
angiotensin-converting enzyme (
ACE) inhibitor, is a
prodrug which is rapidly hydrolyzed after absorption to the active metabolite
ramiprilat. Earlier trials have shown that
ACE inhibitors, when given to patients with low ejection fractions, have reduced the relative risk of
myocardial infarction (MI) and other ischemic events by 14-23%. Subsequently, the double-blind, randomized, placebo-controlled, multicenter Heart Outcomes Prevention Evaluation (HOPE) study has shown that, in patients who are not known to have low ejection fraction or
heart failure but are at increased risk for developing cardiovascular events,
ramipril reduced the incidence of
stroke, MI and death due to
cardiovascular disease. Results from the HOPE study, in which 9297 patients were randomized to receive either
ramipril 10 mg/day or placebo for a mean of 4.5 years, indicate that
ramipril reduced the relative risk of the composite outcome of MI,
stroke and cardiovascular death by 22%. The incidence of the composite outcome was significantly lower in the
ramipril group than in the placebo group (14.0% vs 17.8%). Patients who received
ramipril, compared with placebo recipients, had a significantly decreased incidence of
stroke, MI or death due to
cardiovascular disease (3.4% vs 4.9%, 9.9% vs 12.3% and 6.1% vs 8.1%, respectively). The relative risk of death from any cause was reduced among patients who received
ramipril. In addition, treatment with
ramipril reduced as the incidence of revascularization procedures, and, among patients with
diabetes mellitus,
ramipril reduced the incidence of complications related to
diabetes mellitus, including the development of overt nephropathy. Moreover, in patients without a previous diagnosis of
diabetes mellitus,
ramipril, compared with placebo, significantly reduced the development of
diabetes mellitus. Furthermore, compared with patients receiving placebo, patients receiving
ramipril had a reduced rate of progression of carotid artery wall thickness.
CONCLUSION: