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The Annals of Pharmacotherapy: Vol. 37, No. 3, pp. 412-419. DOI 10.1345/aph.1C262
© 2003 Harvey Whitney Books Company.
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FORMULARY FORUM

Ramipril for the Prevention and Treatment of Cardiovascular Disease

April D Vuong, PharmD

Ambulatory Care Resident, Area Health Education Centers (AHEC), Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, FL

Laura G Annis, PharmD

Clinical Assistant Professor and AHEC Pharmacy Clinical Coordinator, Department of Pharmacy Practice, College of Pharmacy, University of Florida

Reprints: April D Vuong PharmD, 4000 NW 51st St., Apartment #H148, Gainesville, FL 32606-8309, FAX 352/392-9388, E-mail awarner{at}ufl.edu

OBJECTIVE: To evaluate the effectiveness of ramipril in the prevention and treatment of cardiovascular disease and determine its need for inclusion on a formulary.

DATA SOURCES: A MEDLINE and PubMed database search was conducted (1987–May 2002). Only journals written in the English language were selected for review.

DATA EXTRACTION AND STUDY SELECTION: Articles reporting the use of ramipril in humans were evaluated. Emphasis was placed on randomized, controlled trials assessing efficacy.

DATA SYNTHESIS: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor that exerts its effects through inhibition of the renin–angiotensin–aldosterone system. It exhibits a safety profile that is similar to that of other ACE inhibitors and is comparable in cost to the majority of the available agents. Clinical trials have proven the effectiveness of ACE inhibitors in the treatment of hypertension, heart failure, and nephropathy. Ramipril, however, is the only ACE inhibitor currently approved for the prevention of cardiovascular events in high-risk patients without evidence of left-ventricular dysfunction or heart failure, based on the results of the HOPE (Heart Outcomes Prevention Evaluation) trial. Whether this effect is specific to ramipril has yet to be proven. This article emphasizes the major trials involving ramipril including the AIRE (Acute Infarction Ramipril Efficacy), REIN (Ramipril Efficacy in Nephropathy), and HOPE trials.

CONCLUSIONS: Although similar to other ACE inhibitors in many aspects, it cannot be assumed that the benefits shown with ramipril in the HOPE trial are a class effect. Ongoing trials should help to clarify this matter. Until this time, current evidence justifies the inclusion of ramipril on a formulary.

Key Words: angiotensin-converting enzyme inhibitors, cardiovascular disease, ramipril

Published Online, February 3, 2003. www.theannals.com, DOI 10.1345/aph.1C262

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-008-H01




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