Heart Outcomes Prevention Evaluation study in diabetics

Last reviewed 02/2023

The Heart Outcomes Prevention Evaluation (HOPE) study of diabetic patients investigated the role of the ACE inhibitor ramipril in diabetic patients with a cardiovascular risk factor.

3577 patients with diabetes were recruited as part of the HOPE study.

The analysis of the diabetic subgroup of the main trial was planned in advance.

Patients were recruited if they:

  • were diabetic
  • were 55 years or older
  • had a cardiovascular risk factor
  • did not satisfy the exclusion criteria

The primary outcome was the combination of:

  • myocardial infarction
  • stroke
  • cardiovascular death A main outcome was overt nephropathy.

Patients were randomised in a two-by-two factorial manner to:

  • ramipril 10 mg daily or placebo
  • vitamin E or placebo

There were significant benefits for the following end-points in those patients randomised to ramipril:

  • combined primary outcome
  • MI
  • stroke
  • cardiovascular death
  • total mortality
  • revascularisation
  • overt nephropathy


  • (1) HOPE Study Investigators (2000). Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet, 355, 253-59.