Papers p 699

The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiotensin converting enzyme inhibitor ramipril on cardiovascular events and disease progression.1 In this issue the investigators describe the results of preventing stroke (p 699).2 The findings clearly show that ramipril substantially decreased the risk of stroke and transient ischaemic attacks in 9297 patients with high cardiovascular risk. A 32% relative risk reduction was found, while the reduction in blood pressure was only 3.8 mm Hg (systolic) and 2.8 mm Hg (diastolic). This benefit was greater than expected from prior meta-analyses of epidemiological studies or trials in hypertension studies. The results have important implications for the primary and secondary prevention of stroke.

Firstly, it must be emphasised that hypertension is still the most important risk factor for stroke, as shown in all studies on hypertension in recent decades,3 and more recently in the PROGRESS study, in which an average blood pressure reduction of 9/4 mm Hg decreased …