NEW YORK (Reuters Health) Mar 21 – In patients at high risk for stroke, treatment with the ACE inhibitor ramipril reduces the overall stroke rate by almost one-third, according to a report published in the March 23rd issue of the British Medical Journal. The mechanism, however, does not seem to involve the drug's antihypertensive effects.
Dr. Jackie Bosch, from McMaster University in Hamilton, Canada, and colleagues assessed the stroke-related outcomes of 9297 patients who participated in the Heart Outcomes Prevention Evaluation (HOPE) study.
The primary focus of the HOPE study was to determine the impact of treatment with ramipril 10 mg, vitamin E, both, or matching placebos on cardiac outcomes. All of the patients in the current study had cardiovascular disease or diabetes plus one additional risk factor for cerebrovascular events, the authors note. The average follow-up period was 4.5 years.
Patients treated with ramipril were 32% less likely to experience a stroke than those who received placebo. Furthermore, the risk of fatal stroke was reduced by 61% with ramipril use. However, ramipril use was only tied to an average reduction in systolic and diastolic blood pressures of 3.8 and 2.8 mm Hg, respectively.
"Many people previously thought that the effects of ramipril were solely due to its ability to lower blood pressure," Dr. Bosch told Reuters Health. "However, in the current study, ramipril's anti-stroke effect was too great to be explained by the relatively modest reduction in blood pressure that occurred," she added.
The beneficial anti-stroke effects of ramipril were noted in all patients, including those receiving aspirin and other blood-pressure lowering therapies, the authors note
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