The HOPE study: Comparison with other trials of secondary prevention

The HOPE study results, have started a debate on extending the current indications for angiotensin converting enzyme inhibitor treatment to the area of cardiovascular prophylaxis. The recently published recommendations of the second joint task forces of European and other societies on coronary prevention, include ACE inhibitor treatment as one of the five first line drug classes for hypertension. Such treatment is particularly indicated in patients with persistent left ventricular dysfunction. The treatment goal is to obtain a blood pressure below 140/90 mmHg. ACE inhibitor treatment is also recommended in patients with symptoms and signs of heart failure at the time of myocardial infarction, and in asymptomatic left ventricular dysfunction following a myocardial infarction. It is also increasingly used in diabetics with hypertension and microalbumenuria. In the European guidelines on the prevention of coronary heart disease, a treatment goal is also to reduce blood lipids to a total cholesterol <5·0 mmol . l 1 and LDL cholesterol to <3·0 mmol . l . ‘Preference should be given to the HMG CoA reductase inhibitors (statins), as this class of lipid lowering drug has the strongest evidence in coronary heart disease patients for reducing coronary morbidity, mortality and prolonging survival’. These recommendations are based on prior evidence from large clinical trials with ACE inhibitors and statins. It now seems appropriate to discuss the HOPE results in comparison with those from the earlier ACE inhibitor and statin trials. Since the treatment effects in HOPE