Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study

Abstract

Background— Previous trials in the prevention of heart failure have been restricted to patients with low ejection fraction or hypertension. We assessed an angiotensin-converting enzyme (ACE) inhibitor, ramipril, to prevent the development of heart failure in high-risk patients without known low ejection fraction or heart failure. Methods and Results— We randomly assigned 9297 patients to receive double-blind ramipril (10 mg daily) or matching placebo for 4.5 years. Death attributable to heart failure, hospitalization for heart failure, initiation of open-label ACE inhibitor for heart failure, or development of typical signs or symptoms of heart failure developed in 951 patients and was associated with a 4.01-fold increase in the risk of death ( P P P =0.024 for interaction of group by treatment). Conclusion— Ramipril significantly reduces the rate of development of heart failure in patients at high risk of cardiovascular events.