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The incidence of stroke was reduced by 32% with ramipril, myocardial infarction by 20% and cardiovascular death by 25%, while there also were significant reductions in the number of revascularization procedures, cardiac arrests, heart failure, and complications related to diabetes. The reduction in the rate of events began within a year after initiation of treatment with ramipril and persisted throughout follow-up. The benefit of the treatment could not be ascribed to the rather small reduction (3/2 mmHg) in blood pressure. In the diabetic patients ramipril was as effective as in the non-diabetic participants. In addition, it lowered the risk of overt nephropathy by 24%. The cumulative incidence of the primary outcome was higher in patients with mild renal insufficiency than in those without (22.2% vs 15.1%, p < 0.001) and increased with serum creatinine concentration. 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The relative risk reduction was very similar whether or not the patient was a known hypertensive at baseline. In patients who had preexisting vascular disease or diabetes combined with an additional cardiovascular risk factor, mild renal insuf- ficiency significantly increased the risk for subsequent cardiovascular events. Ramipril reduced cardiovascular risk in those patients without increasing adverse effects. Thus, the HOPE trial has directed our attention again to the multifactorial interventions available for reducing cardiovascular complications in patients with diabetes, preexisting cardiovascular disease, and mild renal insufficiency. In addition to strategies to obtain good glycaemic control (in diabetic patients), normal blood pressure, and lipid levels, there is now sufficient evidence that most patients with increased cardiovascular risk will benefit from treatment with the ACE inhibitor ramipril. (N Engl J Med 2000&#59; 342: 145-153&#59; 154-160. 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The HOPE (Heart Outcomes Prevention in Evaluation) trial
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    "textoCompleto" => "NEFROLOGÍA. Vol. XXII. Suplemento 2. 2002 The HOPE (Heart Outcomes Prevention Evaluation) trial. Overall results and the effect of renal insufficiency on cardiovascular disease B. H. R. Wolffenbuttel, MD PhD Assoc. Profesor of Endocrinology and Diabetes. Dept. of Endocrinology. University Hospital Maastricht. The Netherlands on behalf of the HOPE study investigators. INTRODUCTION It has been shown that angiotensin-convertingenzyme inhibitors improve the outcome of patients with left ventricular dysfunction, whether or not they have heart failure. Also, several epidemiologic and experimental studies suggest that the amount of vitamin E ingested in food and in supplements is associated with a lower risk of atherosclerosis and cardiovascular disease. 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