ramipril and stroke 雷米普利与中风.doc

Does Ramipril Prevent Stroke and Stroke-Related Disability? This subanalysis from the HOPE study suggests that the ACEI ramipril reduces stroke risk, perhaps independent of its effects on blood pressure. Preclinical and clinical data suggest that angiotensin-converting-enzyme inhibitors (ACEIs) may reduce the risk for ischemic events independent of the drugs blood pressure-lowering effects. This is an analysis of the impact of the ACEI ramipril on stroke, its subtypes, and related disability from the industry-sponsored Heart Outcomes Prevention Evaluation (HOPE) trial, a double-blind, randomized, 2x2-factorial-designed trial comparing up to 10 mg ramipril, 400 IU of vitamin E, both treatments, or matching placebos. Participants were 9541 people older than 55 who had either histories of cardiovascular or cerebrovascular disease or diabetes plus one additional risk factor. At study entry, 11% had had a previous stroke or TIA, and mean blood pressure (BP) was 139/79 mm Hg. Average follow-up was 4.5 years. BP dropped modestly in the ramipril group (average decrease, 3.8/2.8 mm Hg). Absolute risk reduction (ARR) significantly favored ramipril over placebo for reductions in total stroke (by 1.5%), nonfatal stroke (by 0.9%), and fatal stroke (by 0.6%). The ramipril group also had a significantly larger proportion with no functional impairment (ARR, 0.6%) or only some impairment (ARR, 0.5%) and a smaller proportion with a change in cognition (ARR, 0.5%). The ARR for ischemic stroke with ramipril was 1.2%, but the trend for hemorrhagic-stroke reduction was nonsignificant (ARR, 0.08%). Benefits were observed regardless of baseline BP level, drugs used, and presence or absence of prior stroke, coronary disease, peripheral arterial disease, diabetes, or hypertension. Comment: Ramipril appears to be a winner: These researchers found across-the-board benefits with ramipril for reductions of stroke and its major sequelae. One must interpret the data cautiously, however. The number