Mann J, Sleight P
Klinikum Schwabing, München.
MMW Fortschr Med. 2000 Nov 23;142(47):28-32.
The HOPE study investigated the hypothesis that inhibition of the RAS with the ACE inhibitor, ramipril, prevents cardiovascular events in patients with a high cardiovascular risk. The primary endpoint of the double-blind, placebo-controlled study was the combination of myocardial infarction, stroke and cardiovascular death. The result was a significant reduction in the number of myocardial infarctions (9.9 vs. 12.2%), cardiovascular deaths (6.1 vs. 8.1%), strokes (3.4 vs. 4.9%) and revascularizations (16.0 vs. 18.6%) under the ACE inhibitor. The cough rate was raised (by 5%). The cardio- and nephroprotective benefits of ramipril were largely independent of the reduction in blood pressure achieved by the ACE inhibitor. The effects of rampipril in terms of micro- and macrovascular complications benefitted in particular type 2 diabetics with additional cardiovascular risk factors, so that this group should not be denied ramipril. The level of albumin excretion in the urine is directly coupled with the rate of cardiovascular events.
心脏结局预防评价（HOPE）研究对血管紧张素系统（RAS）抑制剂雷米普利预防心血管高危患者发生心血管事件这一假说进行了调查。这项双盲、安慰剂对照研究的主要终点是心肌梗死、中风和心血管死亡的综合情况。结果显示，在使用血管紧张素转换酶（ACE）抑制剂治疗的患者中，心肌梗死数量（9.9% 对 12.2%）、心血管死亡数量（6.1% 对 8.1%）、中风数量（3.4% 对 4.9%）和血管重建数量（16.0% 对 18.6%）均显著减少。咳嗽发生率有所升高（升高了5%）。雷米普利的心脏保护和肾脏保护益处很大程度上独立于ACE抑制剂所实现的血压降低。雷米普利在微血管和大血管并发症方面的作用尤其使伴有其他心血管危险因素的2型糖尿病患者受益，因此不应拒绝该组患者使用雷米普利。尿白蛋白排泄水平与心血管事件发生率直接相关。
