(Canadian Medical Association Journal) -- The Canadian-led Heart Outcomes Prevention Evaluation (HOPE) involved patients in 19 countries and showed that treatment with ramipril reduced mortality rates, cardiovascular events, complications related to diabetes and the development of diabetes. New research by Karen Tu and colleagues found that the trial also led to an "unprecedented" 400% increase in the prescribing of ramipril to elderly Ontario residents.

The authors tracked the monthly number of new prescriptions for angiotensin-converting-enzyme (ACE) inhibitors in elderly Ontario residents from Jan. 1, 1993, to Mar. 31, 2001. They found the monthly number of new prescriptions for ramipril from the time it was introduced in1995 until HOPE's early termination in April 1999 peaked at 58 per 100 000 elderly Ontario residents. The rate increased to 92/100 000 in May, after reports of the trial's early termination due to its success started appearing, and then declined to 63/100 000 in August. When HOPE's results were formally released starting Aug. 31, 1999, the rate shot up, peaking at 304/100 000 in May 2000. Tu and colleagues state their findings show a "clear and striking increase" in the number of elderly Ontario residents started on ACE-inhibitor therapy.

In a related commentary, Louise Pilote discusses whether this huge increase in ramipril prescriptions was warranted and the effect widespread media coverage of the study had on physicians' decision to prescribe the drug.