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Issue 109 Item 10 Those with Normal Blood Pressure can Decrease Risk of Stroke a

ACE inhibitors cut the incidence of stroke, decrease stroke mortality, and reduce functional impairment following stroke in high-risk patients who have relatively normal blood pressure, reported Dr. Jackie Bosch and associates in the Heart Outcomes Prevention Evaluation (HOPE) study. Their findings show that patients at high risk of stroke should be treated with ACE inhibitors, even if they have normal blood pressure, and in addition to other preventive treatments they may be taking such as aspirin therapy, lipid-lowering agents, antiplatelet drugs, and antihypertensive medications, the researchers said (BMJ 324[7339]:699-702, 2002).

The benefit of ACE inhibitor therapy in preventing cardiac events has been documented in previous reports from the HOPE study, a randomized trial involving 267 hospital clinics in 19 countries in which ramipril was compared with placebo. In the latest analysis of HOPE study data focusing on stroke outcomes, 9,539 high-risk patients were followed at 6-month intervals for an average of 4.5 years.

The number of strokes and stroke fatalities were significantly lower in subjects taking ramipril. Among subjects who developed stroke, significantly fewer of those on ramipril showed cognitive, motor, or speech impairment, compared with those on placebo.

Although ramipril decreased blood pressure modestly (an average of 3.8 mm Hg systolic and 2.8 mm Hg diastolic), the drug’s beneficial effect occurred across a range of blood pressure levels. This confirms that the benefit of ACE inhibitors isn’t confined to hypertensive patients and that their action in preventing stroke is independent of their antihypertensive effect, said Dr. Bosch of McMaster University, Hamilton, Ont., and associates.