Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial
Abstract
Background The cardiovascular risk associated with early renal insufficiency is unknown. Clinicians are often reluctant to use angiotensin-converting enzyme inhibitors in patients with renal insufficiency. Objective To determine whether mild renal insufficiency increases cardiovascular risk and whether ramipril decreases that risk. Design Post hoc analysis. Setting The Heart Outcomes and Prevention Evaluation (HOPE) study, a randomized, double-blind, multinational trial involving 267 study centers. Patients 980 patients with mild renal insufficiency (serum creatinine concentration >/= 124 micromol/L [>/=1.4 mg/dL]) and 8307 patients with normal renal function (serum creatinine concentration Measurements The primary outcome measure was incidence of cardiovascular death, myocardial infarction, or stroke. Results Cumulative incidence of the primary outcome was higher in patients with renal insufficiency than in those without (22.2% vs. 15.1%; P 0.2 for the difference). Conclusions In patients who had preexisting vascular disease or diabetes combined with an additional cardiovascular risk factor, mild renal insufficiency significantly increased the risk for subsequent cardiovascular events. Ramipril reduced cardiovascular risk without increasing adverse effects.
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The evaluation of a subgroup of the HOPE population with renal insufficiency did not show a significant effect on hospitalization for heart failure.
“Furthermore, the evaluation of a subgroup of the HOPE population with renal insufficiency 5 did not show a significant effect on this outcome.”
From Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy (2001) · cites this paper as [5]
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- Authors
- Mann, J. F. E., Gerstein, H. C., Pogue, J., Bosch, J., Yusuf, S., & for the HOPE Investigators
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2001-04-17
- Volume
- 134
- Issue
- 8
- Pages
- 629-636
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2016046345
- Cited by
- 1,372
- References
- 1
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 12 · 2023: 24 · 2022: 17 · 2021: 13 · 2020: 26 · 2019: 23 · 2018: 27 · 2017: 24 · 2016: 35 · 2015: 35 · 2014: 56 · 2013: 58 · 2012: 77
- FWCI
- 76.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- renal failure, cardiovascular risk, ramipril, ACE inhibitors, cardiovascular mortality, myocardial infarction, stroke, serum creatinine, cardiovascular outcomes, diabetes mellitus
- MeSH terms
- Aged, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Diseases, Creatinine, Double-Blind Method, Female, Follow-Up Studies, Humans, Middle Aged, Prognosis, Regression Analysis, Risk Factors, Vascular Diseases, Ramipril, Statistics, Nonparametric, Diabetes Complications, Renal Insufficiency
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