The Heart Outcomes Prevention Evaluation study: angiotensin-converting enzyme inhibitors: are their benefits a class effect or do individual agents differ?

The Heart Outcomes Prevention Evaluation study was a landmark study employi ng the angiotensin-converting enzyme inhibitor ramipril in a patient popula tion pre-destined for vascular events. This study found that a 10 mg dose o f ramipril in comparison with placebo reduced the incidence of death, myoca rdial infarction, stroke, and death from cardiovascular causes by 22%. This improvement in outcome was viewed as a direct consequence of ramipril alth ough the fact that blood pressure was reduced with ramipril has cast some c onsiderable doubt on this supposition. Whether the observed findings in thi s study are a 'class effect' for all angiotensin-converting enzyme inhibito rs is unclear. To its credit, ramipril is the first angiotensin-converting enzyme inhibitor shown to prevent ischemic events in high-risk patients wit hout discernible left ventricular dysfunction. Other similar trials are und erway, which are studying similar populations to those included in this lan dmark study and should resolve the question of whether the cardioprotective effects of angiotensin-converting enzyme inhibitors are a 'class effect'. Curr Opin Nephrol Hypertens 10:597-601. (C) 2001 Lippincott Williams & Wilk ins.