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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog


In 2000, the HOPE Study1 was published in the New England Journal of Medicine.

This study has been followed up for a further two and a half years with about two thirds of the original trial population in the HOPE - The Ongoing Outcomes Study2 (or Hope-TOO). During this open label follow up, patients were assessed for the same outcomes as the original HOPE Study, but of course the placebo arm patients were no longer denied ramipril therapy.

Around 70% of patients in both arms of the study were taking an ACE Inhibitor over the course of the study extension, with over 90% of taking ramipril. The overall effect was that the event rates in the two arms paralleled each other as the effects of the drug in the placebo arm now matched the effects in the active arm.

This study doesn't really add any further evidence but it does increase our confidence that the benefits of ramipril seen under trial conditions can be extended into a more open environment, such as primary care.

Action: ACE Inhibitor use is recommended in patients with hypertension and those who are at high cardiovascular risk. They are also of benefit in protecting renal function in patients with diabetes. Ramipril is a first line ACE Inhibitor.


  1. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. N Engl J Med 2000;342:145-53.
  2. Long-term effects of ramipril on cardiovascular events and on diabetes. HOPE/HOPE-TOO Study Investigators. Circulation 2005;112:1339-1346.

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