The Pharmaceutical Journal
Vol 270 No 7240 p358
15 March 2003

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Prevention of heart failure with ramipril

The angiotensin-converting enzyme (ACE) inhibitor ramipril (Tritace) may prevent heart failure developing in patients at high risk of cardiovascular events. So suggest new data from the HOPE (heart outcomes prevention evaluation) study, first published in 2000.

ACE inhibitors are already known to reduce mortality and morbidity in patients with low ejection fraction or heart failure or both. But, unlike previous trials on the prevention of heart failure, patients in this analysis did not have uncontrolled hypertension or a low ejection fraction — a precursor to heart failure.

In the HOPE trial just under 9,000 high-risk cardiovascular patients, without pre-existing heart failure, received either ramipril (10 mg per day) or placebo for four and a half years. Previously reported results showed a 22 per cent reduction in the primary end point of cardiovascular death, heart attack, or stroke.

In the new analysis, researchers found that heart failure (heart failure death, admission to hospital, treatment or symptoms) occurred in 951 patients and was associated with a fourfold increase in the risk of death. Ramipril reduced new-onset heart failure from 11.5 per cent to 9 per cent, a risk reduction of 23 per cent.

The researchers say that the results extend the benefits of ACE inhibition to an even broader range of patients at high risk of cardiovascular events but without a history of heart failure or low ejection fraction.

They add that this is the first study to show that an ACE inhibitor can prevent heart failure in these patients. "The prevention of heart failure in this population will reduce the high burden of mortality, morbidity, hospitalisation and associated costs," they add (Circulation 2003;107:1284).