Table 2.

Trials Comparing Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers with Placebo in Patients at High Risk of Cardiovascular Events*

Trial	Year	Type of Patient (n)	Years of Follow-up (n)	ACEI Dosage	ARB Dosage	Entry BP (mm Hg)	Mean BP Reduction^† (mm Hg)	Primary Endpoint	Relative Risk	95% CI	P
HOPE²⁶	2000	High risk (n = 9297)	5	Ramipril, 10 mg		139/79	3/2^§	MI, stroke, CV death	0.78	0.70–0.86	<.001
PROGRESS^‡²⁷	2001	Stroke/TIA (n = 2561)	3.9	Perindopril, 4 mg		147/86	5/3	Stroke	0.95	0.81–1.23	NS
EUROPA²⁸	2003	IHD (n = 12,218)	4.2	Perindopril, 8 mg		137/82	5/2	CV death, MI, cardiac arrest	0.80	0.71–0.91	.0003
CAMELOT²⁹	2004	IHD (n = 1328)	2	Enalapril, 20 mg		129/78	6/3	CV events	0.85	0.67–1.07	NS
PEACE³⁰	2004	IHD (n = 8290)	4.8	Trandolapril, 4 mg		133/78	3/1	CV death, MI, revascularization	0.96	0.88–1.06	NS
JIKEI^¶³¹	2007	High risk (n = 3081)	3.1		Valsartan, 40–160 mg	139/81	1/1^‖	CV morbidity/mortality	0.61	0.47–0.79	.0002
TRANSCEND³²	2008	High risk (n = 5926)	4.7		Telmisartan, 80 mg	141/82	4/2	CV death, MI, Stroke, CCF hospitalization	0.92	0.81–1.05	NS
PROFESS³³	2008	Stroke (n = 20,332)	2.5		Telmisartan, 80 mg	144/84	4/2	Stroke	0.95	0.86–1.04	NS

* These trials do not consistently produce a significant reduction of clinical primary end point.
† As compared with placebo.
‡ Results of patients only on perindopril (single drug) compared with placebo.
§ HOPE substudy: Mean 24-hr BP reduction vs placebo, 10/4; P = .03. Mean nighttime BP reduction vs placebo, 17/8; P < .001.
‖ Results of patients on enalapril compared with placebo.
¶ Mean BP reduction vs placebo at 6 months, SBP 2.1 (P = .0005); DBP 2.1 (P < .0001). Mean BP reduction vs placebo at 1 year, SBP 1.5 (P = .0034); DBP 1.3 (P = .0003).
TIA, transient ischemic attack; IHD, ischemic heart disease; ACEI, angiotensin-converting enzyme inhibitor; BP, blood pressure; MI, myocardial infarction; CV, cardiovascular; ARB, angiotensin receptor blocker; CCF, congestive cardiac failure; NS, not significant; HOPE, Heart Outcomes Prevention Evaluation; PROGRESS, Perindopril Protection Against Recurrent Stroke Study; EUROPA, European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease; CAMELOT, Comparison of Arnlodipine vs Enalapril to Limit Occurrences of Thrombosis Trial; PEACE, Prevention of Events with ACEIs Trial; JIKEI, Jikei Heart Study; TRANCSCEND, Telmisartan Randomised Assessment Study in ACE-Intolerant Subjects with Cardiovascular Disease; PROFESS, Prevention Regimen for Effectively Avoiding Second Strokes Trial.