BMJ 2003;326:52 ( 4 January )

Letters

Preventing stroke with ramipril---authors' reply

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EDITOR---Our publication of the effects of ramipril on stroke should be taken in the context of the main publication that described the effects on a number of major clinical outcomes and provides the necessary information to calculate the number needed to treat. 1 2 When one considers all major vascular events prevented, the number needed to treat with ramipril to prevent one event is extremely small (table)


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The side effects of ramipril are described in our main paper, and none of them offset the clinical benefits. Parmar's cost effectiveness analysis is incorrect as it does not take into account the prevention of vascular events and related hospitalisation.3 In a formal cost effectiveness analysis, the use of ramipril for five years is cost neutral.4

Yudkin speculates whether the benefits in the HOPE study can be achieved with other blood pressure lowering agents.3 This is not known. The HOPE results are supported . . . [Full text of this article]
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Relevant Article

Use of ramipril in preventing stroke: double blind randomised trial
Jackie Bosch, Salim Yusuf, Janice Pogue, Peter Sleight, Eva Lonn, Badrudin Rangoonwala, Richard Davies, Jan Ostergren, and Jeff Probstfield
BMJ 2002 324: 699. [Abstract] [Full Text] [PDF]

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