Conundrum of the HOPE study: Time of taking ramipril may account for lack of relation between blood pressure and outcome

doi:10.1136/bmj.327.7416.681-c

BMJ 2003;327:681-682 (20 September), doi:10.1136/bmj.327.7416.681-c

Letter

Conundrum of the HOPE study

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

The first 150 words of the full text of this article appear below.

EDITOR—The conundrum of the HOPE (heart outcomes preventionevaluation) study is resolved.¹ Why was there no relation betweenblood pressure and outcome? Answer: Because ramipril was takenat bedtime.

Separate papers in the BMJ and Lancet reported that risk reductionfor stroke and cardiovascular end points in the HOPE study weremuch greater than could be accounted for by the small reductionin measured blood pressure.^2
3 Both papers suggested that ramiprilhad brought about a specific beneficial effect unrelated toblood pressure lowering. However, neither paper mentioned whenthe ACE inhibitor dose was taken in relation to blood pressuremeasurement.

A previous report by an overlapping authorship reported thatHOPE "is the only large trial in which an antihypertensive agent,according to the study protocol, has been recommended to begiven at bedtime" and that blood pressure was measured on thefollowing day, between 12 and 18 hours . . . [Full text of this article]

Roy Taylor, professor of medicine and metabolism

University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH roy.taylor@ncl.ac.uk

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