What is the role of ACE inhibitors in hypertension ? • In the HOPE (Heart Outcomes Prevention Evaluation) study the use of ramipril was associated with reductions of stroke, coronary artery disease and heart failure in both hypertensive and non-hypertensive groups as compared to placebo (N Engl J Med 2000; 342: 145-53). • In the Captopril Prevention Project (CAPPP) the risk of stroke was slightly greater with ACE inhibitor based therapy than with diuretic-based or beta-blocker based therapy but the higher baseline and follow-up blood pressure among patients assigned the ACE inhibitor regimen may largely or entirely account for the excess risk of stroke (Lancet 1998; 353:611-16).
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