Cost Implications of the Use of Ramipril in High-Risk Patients Based on the Heart Outcomes Prevention Evaluation (HOPE) Study |...
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Risk Stratification in Secondary Prevention | Circulation
In this issue of Circulation, Blankenberg and coauthors7 evaluate the prognostic value of multiple biomarkers compared with that of traditional risk factors on cardiovascular events in a large subgroup of the Heart Outcomes Prevention Evaluation (HOPE) study. The biomarkers examined cover a broad range of inflammation and endothelial activation, including C-reactive protein (CRP) and cellular adhesion molecules, as well as the cardiac neurohormone N-amino terminal of the prohormone brain natriuretic peptide (NT-proBNP). The well-known HOPE study was a randomized, clinical trial investigating ramipril and vitamin E in patients with CHD, peripheral vascular disease, diabetes, or previous stroke. A total of 3199 patients with available blood samples for subsequent biomarker analyses were enrolled in the subgroup examined by Blankenberg et al. Patients were followed up with respect to recurrent cardiovascular events, including myocardial infarction, stroke, and cardiovascular mortality as the ...http://circ.ahajournals.org/content/114/3/184
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Scientists have hypothesized that certain B vitamins (folic acid, vitamin B12, and vitamin B6) might reduce cardiovascular disease risk by lowering homocysteine levels [1,12]. Therefore, several clinical trials have assessed the safety and efficacy of supplemental doses of B vitamins to reduce heart disease risk. Evaluating the impact of vitamin B6 from many of these trials is challenging because these studies also included folic acid and vitamin B12 supplementation. For example, the Heart Outcomes Prevention Evaluation 2 (HOPE 2) trial, which included more than 5,500 adults with known cardiovascular disease, found that supplementation for 5 years with vitamin B6 (50 mg/day), vitamin B12 (1 mg/day), and folic acid (2.5 mg/day) reduced homocysteine levels and decreased stroke risk by about 25%, but the study did not include a separate vitamin B6 group .. Moreover, most other large clinical trials have failed to demonstrate that supplemental B vitamins actually reduce the risk of ...https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/
Abstract 3623: Ramipril Combined with Candesartan Improves Vascular and Metabolic Responses to a Greater Extent Than...
Background: We investigated vascular and metabolic responses to ramipril and candesartan therapies either alone or in combination in hypertensive patients.. Methods: This was a randomized, double-blind, placebo-controlled cross-over trial with three treatment arms (each 2 months) and two washout periods (each 2 months). Thirty-four patients were given ramipril 10 mg and placebo, ramipril 10 mg and candesartan 16 mg, or candesartan 16 mg and placebo daily during each 2 month treatment period.. Results: Ramipril, combined therapy, or candesartan significantly reduced blood pressure after 2 months administration compared with baseline. All three treatment arms did not significantly change the lipoprotein profile. All three treatment arms significantly improved flow-mediated dilator response to hyperemia. However, combined therapy significantly reduced blood pressure and improved flow-mediated dilation to a greater extent than ...http://circ.ahajournals.org/content/114/Suppl_18/II_774.1
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A Study of the Effectiveness and Safety of Ramipril in the Treatment of Hypertension in Children and Adolescents - Tabular View...
Information is needed on the treatment of hypertension in children and adolescents with antihypertensive drugs like ramipril. The study will assess the safety and blood pressure effects of several doses of the antihypertensive drug ramipril in children and adolescents age 6-16 years. Approximately 450 children will be given placebo, or 1 of the 3 doses of ramipril. The treatment assigned will be done by chance, like flipping a coin. Approximately 120 study centers throughout the world will participate in the trial.. Each child will complete a 1- to 4-week Screening Period where they will stop taking their current blood pressure lowering drug(s), a 4-week Treatment Period where they will receive placebo or one of the ramipril doses, and a Follow-up visit 1 week after completion of the Treatment Period. Children diagnosed with hypertension according to the fourth report on the diagnosis, evaluation and treatment of high blood pressure in ...https://clinicaltrials.gov/ct2/show/record/NCT00389519
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Is therapy of people with chronic kidney disease ONTARGET? - Semantic Scholar
The results of the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study were unexpected, demonstrating no cardiovascular or renal benefit but substantial adverse effects of adding an angiotensin II receptor blocker (ARB), telmisartan 80 mg/day, to an angiotensin-converting enzyme (ACE) inhibitor, ramipril 10 mg/day ('dual therapy') vs ramipril alone [1,2]. Those results stirred up a number of commentaries especially from the nephrological community and in most major nephrological journals [3-11]. In this journal, Dr. Abutaleb  brings up a number of concerns related to the design and the renal results of ONTARGET, and we will reply to those concerns in the following. From the beginning, we would like to stress that ONTARGET is the only reliable outcome trial at present to build our judgment on dual therapy outside heart failure and one flawed renal study [13,14]. All other evidence comes from randomized ...https://www.semanticscholar.org/paper/Is-therapy-of-people-with-chronic-kidney-disease-O-Mann-Tobe/d2648c79a8a11bd9decb22f6d9b4186647e23412
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Long-term treatment with ramipril favourably modifies the haemostatic response to acute submaximal exercise in hypertensives.
INTRODUCTION: Hypertension links to a prothrombotic state driven by endothelial dysfunction, reduced fibrinolytic potential and platelet hyperactivity. We hypothesized that ramipril treatment would favourably modify the haemostatic response to a submhttp://www.biomedsearch.com/nih/Long-term-treatment-with-ramipril/23178512.html
Angiotensin-Converting Enzyme Inhibitors for Stroke Prevention | Stroke
The first trial was the HOPE study, in which a 32% (95% CI, 16 to 44) reduction in RR of stroke and 20% (95% CI, 10 to 30) reduction in RR of myocardial infarction (MI) among patients allocated ramipril, compared with placebo, was associated with a reduction in daytime office BP of only 3.3 mm Hg systolic and 1.4 mm Hg diastolic.2,3,6 Because previous epidemiological studies and randomized trials had shown that prolonged reductions in BP of 3.3 mm Hg systolic and 1.4 mm Hg diastolic were associated with only a 13% reduction in stroke and a 5% reduction in MI,1,6 it was hypothesized that most (about two thirds) of the effect of ramipril on serious vascular events in HOPE was attributable to effects of ramipril that were independent of its BP-lowering effect.6 An alternative interpretation of the HOPE data were that the daytime office measurements of BP underestimated the BP-lowering effect of ramipril over 24 hours, after it had been ...http://stroke.ahajournals.org/content/34/2/354.full
Efficacy of Telmisartan and the Combination of Telmisartan and Ramipril in type1 Diabetes Patients With Nephropathy - Full Text...
To evaluate the antialbuminuric efficacy of an angiotensin receptor blocker (ARB) telmisartan and the combination of telmisartan and ramipril in patients with type1 DM and either micro or macroalbuminuria.To evaluate the same drugs for their antihypertensive efficacy and their influence on dipping patterns using ambulatory BP monitoring.. Methods:. Open label cross over study involving 30 patients who were initially treated with telmisartan 80 mg for eight weeks followed by addition of ramipril 10 mg for a further eight weeks. Albuminuria reduction and BP reduction with both clinic and ambulatory BP records were studied at the end of each phase Overnight urine samples of nine hours duration were collected . The volume of urine was verified by measurement in a jar with accuracy of 50ml by the study investigator on every occasion. . Albuminuria was estimated by immuno-turbidimetry Hemocue albumin system Angelholm AD, Sweden (inter assay CV 4.3% ). The albumin excretion ...https://clinicaltrials.gov/show/NCT00738660
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Several of our results show that this low ramipril dose did have a biological effect, however. We detected the expected effects of an ACE inhibitor. The differences in systolic (2.43 mm Hg) and diastolic (1.06 mm Hg) blood pressure between the ramipril and placebo group are of the same magnitude as the differences in the MICRO-HOPE study (2.4 mm Hg, 1.0 mm Hg). In the MICRO-HOPE study the relative reduction in urinary albumin excretion induced by a 10 mg/day dose of ramipril was 22%9 whereas in the DIABHYCAR study the reduction was 14% for a 1.25 mg/day dose. This reduction was measured in a subgroup of French patients who survived and completed the trial, which underestimates the actual effect because of the exclusion by death of the patients with the most serious illnesses. The increased incidence of cough in the group taking ramipril also confirms-through the presence of an expected adverse effect-the biological efficacy of the 1.25 mg ...http://www.bmj.com/content/328/7438/495