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We appreciate the discussion provided by several readers and hope to highlight and clarify several key points. Foremost, achieving optimal blood pressure control, independent of the specific agent or agents selected, is critical to effective risk reduction. Some of the important clinical questions remaining are whether, at an identical level of blood pressure control, ACE inhibitors provide additional protection against atherothrombotic events compared with other antihypertensive agents, particularly ARBs, and whether ACE inhibition reduces risk independent of its blood pressure–lowering effects.

The HOPE trial found that ramipril decreases cardiovascular events in high-risk patients, with a suggestion that the benefits of ramipril exceeded those expected from office-based blood pressure measurements.¹ While the ambulatory blood pressures in a subset of HOPE patients demonstrate more significant reduction than the office-based measurements,² the office-based blood pressure remains the appropriate measure to compare the results of the HOPE trial with other large trials . . . [Full Text of this Article]

Douglas S. Jacoby, MD; Daniel J. Rader, MD
Philadelphia, Pa

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