Trial reportBMJ (Clinical research ed.)2002
Use of ramipril in preventing stroke: double blind randomised trial.
Trial report in BMJ (Clinical research ed.), 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 104 papers, 5 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
104 citing papers in PubMed, 5 syntheses or guidelines pooled it, 417 citations in OpenAlex.
- Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?Journal of the American Heart Association · 2021Pooled it
- Pooled it
- Vascular cognitive impairment: disease mechanisms and therapeutic implications.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2011Pooled it
- [European Stroke Organisation 2008 guidelines for managing acute cerebral infarction or transient ischemic attack : part 2].Der Nervenarzt · 2008Guideline
- Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV.Journal of human hypertension · 2004Guideline
- Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes.Hypertension (Dallas, Tex. : 1979) · 2021Trial
- Trial
- Blood pressure after recent stroke: baseline findings from the secondary prevention of small subcortical strokes trial.American journal of hypertension · 2013Trial
- Diuretic use is associated with better learning and memory in older adults in the Ginkgo Evaluation of Memory Study.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2012Trial
- The Secondary Prevention of Small Subcortical Strokes (SPS3) study.International journal of stroke : official journal of the International Stroke Society · 2011Trial
- Trial
- Telmisartan to prevent recurrent stroke and cardiovascular events.The New England journal of medicine · 2008Trial
- Trial
- The effects of losartan compared to atenolol on stroke in patients with isolated systolic hypertension and left ventricular hypertrophy. The LIFE study.Journal of clinical hypertension (Greenwich, Conn.) · 2005Trial
- Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study).BMJ (Clinical research ed.) · 2004Trial
- Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.Current hypertension reports · 2002Trial
- The Losartan Intervention for Endpoint Reduction (LIFE) trial-have angiotensin-receptor blockers come of age?Journal of clinical hypertension (Greenwich, Conn.)Trial
- Chronic Treatment of a Mouse Model of Cerebral Amyloid Angiopathy and Brain ATbioRxiv : the preprint server for biology · 2025Article
- Article
- ACE Inhibitors and Angiotensin Receptor Blockers for the Primary and Secondary Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus in Collaboration with the CVREP Foundation.Cardiology and therapy · 2024Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
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- SummaryForPatientsIn
Authors and funding
10 authors at 6 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the effect of the angiotensin converting enzyme inhibitor ramipril on the secondary prevention of stroke.
designRandomised controlled trial with 2x2 factorial design.
setting267 hospitals in 19 countries.
participants9297 patients with vascular disease or diabetes plus an additional risk factor, followed for 4.5 years as part of the HOPE study. OUTCOME MEASURES: Stroke (confirmed by computed tomography or magnetic resonance imaging when available), transient ischaemic attack, and cognitive function. Blood pressure was recorded at entry to the study, after 2 years, and at the end of the study.
resultsReduction in blood pressure was modest (3.8 mm Hg systolic and 2.8 mm Hg diastolic). The relative risk of any stroke was reduced by 32% (156 v 226) in the ramipril group compared with the placebo group, and the relative risk of fatal stroke was reduced by 61% (17 v 44). Benefits were consistent across baseline blood pressures, drugs used, and subgroups defined by the presence or absence of previous stroke, coronary artery disease, peripheral arterial disease, diabetes, or hypertension. Significantly fewer patients on ramipril had cognitive or functional impairment.
conclusionRamipril reduces the incidence of stroke in patients at high risk, despite a modest reduction in blood pressure.
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Registered trials
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.