Blood pressure lowering and ACE inhibition for the avoidance of cardiac and cerebral events

Abstract

See doi:10.1016/S1095-668X(02)00804-7for the article to which this editorial refers. It is now well established that the level of blood pressure, whether systolic or diastolic, is an important determinant of the risks of both stroke and heart attack—not only among those with high blood pressure but also among those with average or below average blood pressure levels.1 However, while numerous clinical trials have demonstrated that blood pressure lowering treatments reduce the risks of stroke and of heart attack in hypertensives,2,3 until recently there has been little evidence about the effects of such therapy in non-hypertensives. Since many individuals at very high risk of stroke or heart attack do not have hypertension, there is a considerable interest in determining whether there are benefits of blood pressure lowering agents for high-risk individuals with average or below average blood pressure levels. This question mirrors another posed a decade ago about the effects of blood cholesterol lowering in high-risk patients with average or below average cholesterol levels—a question answered decisively by trials of statins in patients with coronary heart disease.4–6 Over the past 2 years, two major trials have been completed that have demonstrated important benefits of ACE inhibitor-based regimens for patients at high risk of coronary events or stroke, whether hypertensive or non-hypertensive. The Heart Outcomes Protection Evaluation (HOPE) study was designed to determine the effects of treatment with ramipril …