TEN YEARS AFTER PUBLISHING RESULTSFROM THE HEART OUTCOMES PREVENTION EVALUATION STUDY – HOPE:IMPLICATIONS ON TREATMENT WITH ANGIOTENSIN CONVERTING ENZYME INHIBITORSIN CLINICAL PRACTICE

Abstract

Rezultati HOPE ispitivanja (Heart Outcomes Prevention Evaluation Study) publicirani prije deset godina, utjecali su na mjesto ACE-inhibitora u kliničkoj praksi. Usporedba primjene ramiprila u dozi do 10 mg ili placeba na 9541 ispitaniku s povišenim kardiovaskularnim rizikom tijekom 4,5 godine pokazala je smanjenje relativnog rizika svih praćenih kardiovaskularnih komplikacija: kardiovaskularne smrtnosti, infarkta miokarda i moždanog udara za 22% u skupini koja je liječena ramiprilom, uz minimalni pad sistoličkoga krvnog tlaka od 3 mmHg. Učinak je bio povoljan neovisno o dobi, spolu i pridruženim bolestima te drugoj terapiji. Produljenje praćenja ispitanika dokazalo je da se povoljan učinak zadržava daljnjih 2,6 godina. Zabilježeno je i smanjenje relativnog rizika od novonastalog dijabetesa za 34%. Rezultati ispitivanja između ostalog su utjecali na uvrštavanje ACE-inhibitora u sve smjernice za liječenje kardiovaskularnih i dijabetičnih bolesnika. Prvo je to ispitivanje u primjeni ACE-inhibitora u primarnoj prevenciji kardiovaskularnih komplikacija kod visokorizičnih bolesnika.Ten years ago results from The Heart Outcomes Prevention Evaluation Study were published. Those results had a great impact on position of ACE inhibitors in clinical practice. In the study, comparsion of ramipril in daily dosage up to 10 mg and placebo in 9541 patients with high cardiovascular risk during 4.5 years of follow-up resulted in relative risk reduction for all primary end-points: cardiovascular mortality, myocardial infarction and stroke for 22% in patients treated with ramipril. Systolic blood pressure was reduced minimally for 3 mmHg. The effect was indipendent of age, gender, concomitant diseases or therapy. Extended follow-up of the patients for further 2.6 years showed prolonged beneficial effect of ramipril. Ramipril reduced relative risk for newly developed diabetes for 34%. Results of the study greatly influenced the guidelines for treatment of patients with cardiovascular diseases. This study proved benefits of ACE inhibitors in primary prevention in patients with high cardiovascular ris