Evidence map›Paper›PMID 10639539›Full record

Trial reportThe New England journal of medicine2000

Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients.

Heart Outcomes Prevention Evaluation Study Investigators, S Yusuf, P Sleight, J Pogue, J Bosch, R Davies, G Dagenais

Erratum issued 8 registry-linked trialsOpen access · greenAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 8 registered trials, which are not on this map. Cited by 1,835 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,835citing papers in PubMed, 17 pooled it
434.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00108706 phase4unknown statusnot on this mapstarted 2004, after this paper: background citation

Acute Candesartan Cilexetil Outcomes Stroke Trial (ACCOST)

TypeinterventionalSponsorCity Hospitals Sunderland NHS Foundation TrustRan2004 to 2007Enrolled50ConditionsCerebrovascular Accident, Acute StrokeArmsCandesartan
NCT00291720 phase2completednot on this mapstarted 2005, after this paper: background citation

Is Spironolactone Safe and Effective in the Treatment of Cardiovascular Disease in Mild Chronic Renal Failure?

TypeinterventionalSponsorUniversity Hospital BirminghamRan2005 to 2007Enrolled120ConditionsChronic Kidney Disease, Cardiovascular DiseaseArmsSpironolactone, Placebo
NCT00736294 phase3terminatednot on this mapstarted 2008, after this paper: background citation

Prevention of Atrial Fibrillation by the Prescription of Inhibition Conversion Enzyme (ICE) After Radiofrequency Ablation of Atrial Flutter

TypeinterventionalSponsorCentre Hospitalier Universitaire de Saint EtienneRan2008 to 2015Enrolled198ConditionsAtrial Fibrillation, Atrial FlutterArmsRamipril, Placebo
NCT00761969 completednot on this mapstarted 2004, after this paper: background citation

Prevention of Ischemic Events in Patients With Peripheral Arterial Disease by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

TypeobservationalSponsorKRKARan2004 to 2014Enrolled1,455ConditionsPeripheral Arterial DiseaseArmsImplementation of the European Guidelines on cardiovascular Disease Prevention in Clinical Practice
NCT01052272 phase2 / phase3completednot on this mapstarted 2005, after this paper: background citation

Phase 2/3 Study of Effect of AT1RB Versus ACE Inhibitor in Addition to XO Inhibitor on Progression of LV Remodeling and Dysfunction in Diabetic Patients With Acute MI.

TypeinterventionalSponsorUniversity of Alabama at BirminghamRan2005 to 2010Enrolled72ConditionsDiabetesArmsRamipril, Candesartan cilexetil, Allopurinol
NCT01669928 phase4completednot on this mapstarted 2012, after this paper: background citation

Hellenic Anglo Research Into Morning Or Evening Antihypertensive Drug deliverY Trial

TypeinterventionalSponsorImperial College LondonRan2012 to 2015Enrolled103ConditionsHypertensionArmsAnti-hypertensive Medication -
NCT02403349 phase4unknown statusnot on this mapstarted 2012, after this paper: background citation

Comparison of Peripheral and Cerebral Arterial Flow in Acute Ischemic Stroke: Fimasartan vs. Valsartan vs. Atenolol

TypeinterventionalSponsorAjou University School of MedicineRan2012 to 2015Enrolled105ConditionsBlood Pressure, Ischemic StrokeArmsFimasartan, Valsartan, Atenolol
NCT03201185 phase4unknown statusnot on this mapstarted 2018, after this paper: background citation

Beneficio Del Bloqueo Del Sistema Renina-angiotensina Sobre la evolución clínica y el Remodelado Ventricular Tras la colocación de Una prótesis percutánea aórtica (RASTAVI)

TypeinterventionalSponsorHospital Clínico Universitario de ValladolidRan2018 to 2023Enrolled194ConditionsTranscatheter Aortic Valve Replacemen, Angiotensin-Converting Enzyme InhibitorsArmsRamipril
3 · Its place in the literature

Who cites it

1,835 citing papers in PubMed, 17 syntheses or guidelines pooled it, 8,641 citations in OpenAlex.

  1. Efficacy and Safety of ARB-Based Combination Therapies for Treatment of Hypertension: A Systematic Review and Meta-analyses.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026
    Pooled it
  2. Pooled it
  3. Guideline
  4. Guideline
  5. Pharmacotherapy for hypertension in adults 60 years or older.The Cochrane database of systematic reviews · 2025
    Pooled it
  6. Pharmacotherapy for mild hypertension.The Cochrane database of systematic reviews · 2025
    Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Guideline
  11. Evening versus morning dosing regimen drug therapy for hypertension.The Cochrane database of systematic reviews · 2024
    Pooled it
  12. Guideline
  13. Antioxidants for adults with chronic kidney disease.The Cochrane database of systematic reviews · 2023
    Pooled it
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  18. Trial
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1,775 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Heart Outcomes Prevention Evaluation Study Investigators
S YusufCanadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, McMaster University, ON. hope@ccc.mcmaster.ca
P Sleight
J Pogue
J Bosch
R Davies
G Dagenais
McMaster University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAngiotensin-converting-enzyme inhibitors improve the outcome among patients with left ventricular dysfunction, whether or not they have heart failure. We assessed the role of an angiotensin-converting-enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events but who did not have left ventricular dysfunction or heart failure.

methodsA total of 9297 high-risk patients (55 years of age or older) who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low ejection fraction or heart failure were randomly assigned to receive ramipril (10 mg once per day orally) or matching placebo for a mean of five years. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes. The trial was a two-by-two factorial study evaluating both ramipril and vitamin E. The effects of vitamin E are reported in a companion paper.

resultsA total of 651 patients who were assigned to receive ramipril (14.0 percent) reached the primary end point, as compared with 826 patients who were assigned to receive placebo (17.8 percent) (relative risk, 0.78; 95 percent confidence interval, 0.70 to 0.86; P<0.001). Treatment with ramipril reduced the rates of death from cardiovascular causes (6.1 percent, as compared with 8.1 percent in the placebo group; relative risk, 0.74; P<0.001), myocardial infarction (9.9 percent vs. 12.3 percent; relative risk, 0.80; P<0.001), stroke (3.4 percent vs. 4.9 percent; relative risk, 0.68; P<0.001), death from any cause (10.4 percent vs. 12.2 percent; relative risk, 0.84; P=0.005), revascularization procedures (16.3 percent vs. 18.8 percent; relative risk, 0.85; P<0.001), cardiac arrest (0.8 percent vs. 1.3 percent; relative risk, 0.62; P=0.02), [corrected] heart failure (9.1 percent vs. 11.6 percent; relative risk, 0.77; P<0.001), and complications related to diabetes (6.4 percent vs. 7.6 percent; relative risk, 0.84; P=0.03).

conclusionsRamipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.

Indexed as

AgedAngiotensin-Converting Enzyme InhibitorsCardiovascular DiseasesDiabetes ComplicationsDiabetes MellitusDouble-Blind MethodFemaleHumansMaleMiddle AgedMyocardial InfarctionRamiprilRisk FactorsStrokeTreatment OutcomeAngiotensin-Converting Enzyme InhibitorsRamipril

Identifiers

PMID10639539
OpenAlexW180946569

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.