This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with interest the excellent review by Jacoby and Rader¹ defining the role of the renin-angiotensin system in the pathogeneses of vascular disease. Six clinical trials in patients with normal ejection fractions were presented as evidence for the vascular protective effects of ACE inhibitors.

We would like to point out that the impressive benefit seen in patients with prior strokes in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) occurred only after the diuretic indapamide was added, and no benefit was seen from perindopril alone.²

The striking benefit of ramipril over placebo in the Heart Outcomes Prevention Evaluation (HOPE) trial initially was believed to be greater than the expected benefit from the observed 3 mm Hg lower systolic blood pressure in the ramipril-treated patients. Ambulatory monitoring in a small subset of HOPE patients, however, demonstrated a significantly larger blood pressure lowering with ramipril. Thus it is possible that the . . . [Full Text of this Article]

William H. Carter, MD; Greg Rosencrance, MD
Charleston, WVa