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 …

Reviewing Author

Philip B. Gorelick, MD, MPH