Prolonged use of ramipril prevents stroke

Patients who are at high risk of stroke should be treated with the drug ramipril, irrespective of their initial blood pressure levels and in addition to other preventive treatments such as blood pressure lowering agents or aspirin, finds a study in this week’s BMJ.

Over 9,000 patients aged 55 or over and at high risk of stroke received either ramipril or placebo. Patients were seen after six months and then every six months for an average of four and a half years.

Although reduction in blood pressure was modest, the risk of any stroke was reduced by 32% in the ramipril group compared with the placebo group. The risk of fatal stroke was reduced by 61% and significantly fewer patients on ramipril had mental or functional impairment. As stroke is the leading cause of disability in developed countries, even moderate decreases in disability would be of global importance, say the authors.

Widespread use of a drug such as ramipril in patients at high risk of stroke is likely to have a major impact on public health, they conclude.

The study was sponsored by the Canadian Institutes of Health Research in addition to Aventis Pharma, AstraZeneca, King Pharmaceuticals, the Natural Source Vitamin E Association, NEGMA Pharmaceuticals and the Heart and Stroke Foundation of Ontario. The study was coordinated in Hamilton, Canada at McMaster University.