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Blood-Pressure Drug Thwarts Strokes, Too

It benefits people who don't have high blood pressure

THURSDAY, March 21, 2002 (HealthDayNews) -- Ramipril, a drug approved to combat high blood pressure, also offers substantial protection against a stroke.

The latest analysis of data from a four-year study of the drug shows that people at high risk of stroke can benefit from the medication, regardless of their blood pressure or whether they are taking another drug for hypertension, a report in the latest British Medical Journal says.

Ramipril, marketed in the United States as Altace, is a member of the family of drugs called ACE inhibitors, which are designed to treat high blood pressure. Ramipril reduces blood pressure by preventing production of angiotensin II, a molecule that constricts blood vessels.

The HOPE (Heart Outcomes Intervention Evaluation) study, carried out in 129 medical centers in North and South America from 1995-99, has already shown that ramipril can substantially reduce the risk of heart attack, stroke and other cardiovascular diseases.

The first report on the study, published two years ago, said the 9,297 participants who took ramipril were 20 percent less likely to have a heart attack, 31 percent less likely to have a stroke, 25 percent less likely to die from any cardiovascular disease, and 30 percent less likely to develop diabetes than those taking a placebo.

The U.S. Food and Drug Administration approved the use of ramipril in December 2000 to reduce the risk of heart attacks, strokes and all cardiovascular deaths.

"Widespread use of this agent would lead to the prevention of 1 or 2 million major cardiovascular events or diabetic events," says HOPE study author Dr. Salim Yusuf.

The latest analysis, which just looked at the effect of ramipril on stroke, "again shows a very significant benefit," says Dr. Eva Lonn, associate professor of cardiology at McMaster University in Hamilton, Canada, and a member of the study team.

Ramipril reduced the risk of stroke by 32 percent in the study participants, and the risk of fatal stroke by 61 percent, the new study says.

Reduction of blood pressure is only partly why ramipril is so effective at reducing the risk of stroke, Lonn says. "It also has some other beneficial effects on the artery wall," she explains.

The drug's most significant side effect is a dry cough, which usually stops within a few days but can persist for months in about 5 percent of those who take it, Lonn says. The cough can be bothersome enough to force some people to stop taking the drug.

Other ACE inhibitors might have the same overall beneficial effect, Lonn adds, but the scientific evidence is not yet available.

What To Do

"Ramipril should be used in patients similar to those in the HOPE trial. In general, people over the age of 55 with heart or blood vessel disease, and also in patients with diabetes, even in the absence of vascular disease," she says. "To those patients, ramipril is highly effective in reducing overall cardiovascular events, particularly stroke."

To learn more about ACE inhibitors and other blood pressure drugs, consult the American Heart Association or The National Library of Medicine.

SOURCES: Salim Yusuf, M.D, and Eva Lonn, M.D., associate professor, cardiology, McMaster University, Hamilton, Canada; March 23, 2002, British Medical Journal
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