HOPE研究PPT课件.pptVIP

Effects of an Angiotensin-Converting Enzyme Inhibitor, Ramipril, on Death from Cardiovascular Causes, Myocardial Infarction, and Stroke in High-Risk Patients The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators HOPE - Background ACEIs improve the outcome in patients with LV dysfunction, whether or not they have symptomatic heart failure. This study assessed the role of an ACEI, ramipril, in patients who were at high risk for cardiovascular events but who did not have LV dysfunction or heart failure. HOPE - Design A total of 9,297 high-risk patients, 55 years old, who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low EF or heart failure were randomly assigned to receive ramipril (10 mg per day) or matching placebo for a mean of 5 years. The primary outcome was a composite of MI, stroke or death from cardiovascular causes. Each of these endpoints were also analyzed separately. Secondary endpoints were death from any cause, the need for revascularization, hospitalization for unstable angina or heart failure, and complications related to diabetes. HOPE - Baseline Characteristics HOPE - Compliance More patients in the ramipril group versus the placebo group stopped treatment because of cough (7.3% versus 1.8%) or hypotension or dizziness (1.9% versus 1.5%) By contrast, more patients in the placebo group than in the ramipril group stopped treatment because of uncontrolled hypertension (3.9% versus 2.3%) or because of a clinical event - a primary or secondary outcome (9.0% versus 6.7%) 5.3% of patients in the ramipril group and 7.2% of patients in the placebo group received open label ACEI for heart failure HOPE - Kaplan-Meier Estimates of the Composite Endpoint of CV Death, MI or Stroke in the Ramipril and Placebo Groups HOPE - Primary Endpoint Results HOPE - Primary Endpoint Results HOPE - Vitamin E Outcomes Results HOPE - Summary of Results Patients randomized to ramipril had