1. Summary of Design
Aim: Effect of Ramipril (up to 10mg/d) or Vit E (400 IU/d) vs its placebo on CV death, M I or stroke (primary)
Design: Randomized double blind, 2x2 factorial,
People with high CV risk, exclusion: macroalbuminuria, s-creatinine > 2.3 mg/dl
Size: 9541 patients followed for 4 to 6 years:
Organization: 267 hospitals from 19 countries in North & South America and Europe, Coordinated by the CCC at McMaster University, Hamilton, Canada
Principal investigator: S . Yusuf, Coordinator Europe: J Mann, J Ostergren, B. Wolfenbuttel GD

2. G E R
Gerstein, Mann, Yusuf, JAMA 2001; 286:

3. ACR and future development of clinical proteinuria / overt nephropathy
Baseline microalbuminuria was associated with the
development of clinical proteinuria in:
Diabetes: % / 4 years
No diabetes: % / 4 years
In those with microalbuminuria, the risk was fold
higher than in those without (p< after adjusting for
all risk factors monitored in HOPE)

4. Progression of Albuminuria: MA  ON or None  MA/ON
Ramipril Placebo
N (%) N (%)
All patients 909 (19) (22)
RR (95% CI) ( )
p =
MA: microalbuminuria ON: overt nephropathy

5. Serum creatinine (mg/dl)
Serum creatinine in all diabetic patients, and in diabetics with renal insufficiency (RI)
N = 333
Serum creatinine (mg/dl)
Mann, Gerstein, et al, Ann Int Med 2002
N = 3,571
years