Letter

Conundrum of the HOPE study

Time of taking ramipril may account for lack of relation between blood pressure and outcome

BMJ 2003; 327 doi: 10.1136/bmj.327.7416.681-c (Published 18 September 2003)
Cite this as: BMJ 2003;327:681.4

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  1. Roy Taylor, professor of medicine and metabolism (roy.taylor@ncl.ac.uk)
  1. University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH

    EDITOR—The conundrum of the HOPE (heart outcomes prevention evaluation) study is resolved.1 Why was there no relation between blood pressure and outcome? Answer: Because ramipril was taken at bedtime.

    Separate papers in the BMJ and Lancet reported that risk reduction for stroke and cardiovascular end points in the HOPE study were much greater than could be accounted for by the small reduction in measured blood pressure.2 3 Both papers suggested that ramipril …

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