HOPE Trial Inclusion Criteria
The HOPE trial enrolled patients aged ≥55 years who were at high risk for cardiovascular events, defined as having either existing/previous cardiovascular disease OR diabetes mellitus with at least one additional cardiovascular risk factor. 1, 2
Primary Age Requirement
High-Risk Cardiovascular Profile (Must Meet ONE of the Following):
Option 1: Established Vascular Disease
- History of coronary artery disease (CAD) - 11% of enrolled patients had prior stroke/TIA 1
- Previous cardiovascular events (myocardial infarction, unstable angina, coronary revascularization) 2, 4
- Peripheral vascular disease 1, 2
- Previous stroke or transient ischemic attack 1
Option 2: Diabetes Mellitus PLUS At Least One Additional Risk Factor
- Diabetes mellitus (type 1 or type 2) with any of the following: 1, 2, 4
- Known vascular disease
- Cigarette smoking
- Hypertension
- High cholesterol (dyslipidemia)
Critical Exclusion Criteria
The following patients were explicitly excluded from HOPE:
- Clinical proteinuria (overt nephropathy at baseline) 4
- Heart failure (symptomatic) 2, 4
- Low ejection fraction (left ventricular systolic dysfunction) 4
- Current ACE inhibitor use 4
Study Population Characteristics
The final enrolled cohort of 9,541 patients included: 2, 3
- 36-37.5% with diabetes mellitus (3,577 diabetic patients) 5, 3, 4
- 27% women 3
- Nearly 50% with history of hypertension, though baseline blood pressure was normal 2
- Substantial proportion already on antihypertensive drugs (excluding ACE inhibitors), lipid-lowering agents, or aspirin 2
Important Clinical Context
The HOPE trial specifically targeted a "high-risk but stable" population - patients with cardiovascular risk factors or established disease but without acute decompensation or severe organ dysfunction. 2, 4 This design allowed evaluation of ramipril's vasculoprotective effects beyond blood pressure reduction in patients who would benefit from primary or secondary prevention strategies. 6, 7