Patients at high risk of stroke should be treated with the ACE inhibitor ramipril, trials at 267 hospitals in 19 countries has shown.
"Our results indicate that patients who are at high risk of stroke should be treated with ramipril, irrespective of their initial blood pressure levels and in addition to other preventive treatments such as blood pressure lowering agents or aspirin," declares Dr Jackie Bosch, Canadian Cardiovascular Collaboration, McMaster University, Hamilton, Ontario, and lead author of the report.
"Widespread use of an angiotensin converting enzyme inhibitor such as ramipril in patients at high risk of stroke is likely to have a major impact on public health."
The international investigation was among 9, 297 patients with vascular disease, or diabetes, plus an additional risk factor, followed for 4.5 years. The cohort is part of the HOPE study, a double blind randomised trial with a two by two factorial design, in which participants were randomised to receive up to 10 mg of ramipril, 400 IU of vitamin E, both, or matching placebos.
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