Advertisement
ADVANCED SEARCH

This Article Full Text Full Text (PDF) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tu, K. Articles by Tu, J. V. Search for Related Content PubMed PubMed Citation Articles by Tu, K. Articles by Tu, J. V. Related Collections Drugs: cardiovascular system Diabetes Related Article

The striking effect of the Heart Outcomes Prevention Evaluation (HOPE) on ramipril prescribing in Ontario

From the Institute for Clinical Evaluative Sciences, Toronto, Ont. (all authors); the University Health Network-Toronto Western Hospital Family Medicine Centre and the Department of Family and Community Medicine-Family Healthcare Research Unit, University of Toronto (K. Tu); the Department of Pharmacy, University of Toronto (Mamdani); and the Division of General Internal Medicine and the Clinical Epidemiology and Health Care Research Program, Sunnybrook and Women's College Health Science Centre, Toronto, and the departments of Medicine and of Public Health Sciences and Health Policy Management and Evaluation, University of Toronto (J.V. Tu).

Correspondence to: Dr. Karen Tu, Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; karen.tu{at}ices.on.ca

Background: The Heart Outcomes Prevention Evaluation (HOPE), a Canadian-led, multicentre, randomized controlled trial, demonstrated the effectiveness of the ACE inhibitor ramipril in the secondary prevention of cardiovascular disease in patients who were at high risk for cardiovascular events but did not have left ventricular dysfunction or heart failure. We studied whether HOPE affected the prescribing of ACE inhibitors generally, and ramipril specifically, in Ontario, where the trial was coordinated.

Methods: We used linked administrative databases to examine prescribing patterns for ACE inhibitors in the 1.29 million to 1.54 million elderly (aged 66 and over) residents of Ontario during the study period and specifically those with diabetes or congestive heart failure. For all new prescriptions for these drugs filled between Jan. 1, 1993, and Mar. 31, 2001, we conducted time-series analyses to measure any association with the release of the HOPE results.

Results: The monthly number of new prescriptions for ramipril from the time it was introduced in 1995 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, coincident with newspaper coverage of the trial's early termination, then fell back to 63/100 000 in August. After HOPE's results were formally released, starting Aug. 31, the rate increased significantly; it peaked at 304/100 000 in May 2000 (p < 0.01). The market share of ramipril among ACE inhibitors also increased significantly (p < 0.01), both overall and among patients with diabetes or congestive heart failure.

Interpretation: HOPE led to a striking and unprecedented increase, over 400%, in ramipril prescribing to elderly Ontario residents, including those not eligible for the trial. Many physicians are now prescribing ramipril for patients with diabetes or congestive heart failure.

This article has been cited by other articles:

				N. K Choudhry, B. Zagorski, J. Avorn, R. Levin, K. Sykora, A. Laupacis, and M. Mamdani Comparison of the Impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial on Prescribing Patterns: A Time-Series Analysis Ann. Pharmacother., November 1, 2008; 42(11): 1563 - 1572. [Abstract] [Full Text] [PDF]

				C. A. Jackevicius, J. V. Tu, J. S. Ross, D. T. Ko, and H. M. Krumholz Use of Ezetimibe in the United States and Canada N. Engl. J. Med., April 24, 2008; 358(17): 1819 - 1828. [Abstract] [Full Text] [PDF]

				A. X. Garg, T. Greene, and N. W. Levin A well-conducted randomized trial that establishes no benefit of therapy is an important medical advance Nephrol. Dial. Transplant., January 1, 2008; 23(1): 52 - 55. [Full Text] [PDF]

				P. A. Kurdyak, D. N. Juurlink, and M. M. Mamdani The Effect of Antidepressant Warnings on Prescribing Trends in Ontario, Canada Am J Public Health, April 1, 2007; 97(4): 750 - 754. [Abstract] [Full Text] [PDF]

				P. J. Hauptman, M. A. Schnitzler, J. Swindle, and T. E. Burroughs Use of nesiritide before and after publications suggesting drug-related risks in patients with acute decompensated heart failure. JAMA, October 18, 2006; 296(15): 1877 - 1884. [Abstract] [Full Text] [PDF]

				P. C Austin, M. M Mamdani, and D. N Juurlink How Many "Me-Too" Drugs Are Enough? The Case of Physician Preferences for Specific Statins Ann. Pharmacother., June 1, 2006; 40(6): 1047 - 1051. [Abstract] [Full Text] [PDF]

				K. Tu, N. R.C. Campbell, M. Duong-Hua, and F. A. McAlister Hypertension Management in the Elderly Has Improved: Ontario Prescribing Trends, 1994 to 2002 Hypertension, June 1, 2005; 45(6): 1113 - 1118. [Abstract] [Full Text] [PDF]

				S. C. Goehde, P. Hunold, F. M. Vogt, W. Ajaj, M. Goyen, C. U. Herborn, M. Forsting, J. F. Debatin, and S. G. Ruehm Full-Body Cardiovascular and Tumor MRI for Early Detection of Disease: Feasibility and Initial Experience in 298 Subjects Am. J. Roentgenol., February 1, 2005; 184(2): 598 - 611. [Abstract] [Full Text] [PDF]

				L. Pilote, M. Abrahamowicz, E. Rodrigues, M. J. Eisenberg, and E. Rahme Mortality Rates in Elderly Patients Who Take Different Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction: A Class Effect? Ann Intern Med, July 20, 2004; 141(2): 102 - 112. [Abstract] [Full Text] [PDF]

				K. M. Field, J. L. Pepin, and M. D. Mehta Knowing When to Play the Ace: The Use and Under Use of Ace Inhibitors in Primary Practice Journal of Pharmacy Practice, June 1, 2004; 17(3): 197 - 210. [Abstract] [PDF]

				A. Schieppati and G. Remuzzi Fighting Renal Diseases in Poor Countries: Building a Global Fund with the Help of the Pharmaceutical Industry J. Am. Soc. Nephrol., March 1, 2004; 15(3): 704 - 707. [Abstract] [Full Text] [PDF]

				P. C. Austin, M. M. Mamdani, K. Tu, and M. Zwarenstein Changes in Prescribing Patterns Following Publication of the ALLHAT Trial JAMA, January 7, 2004; 291(1): 44 - 45. [Full Text] [PDF]

				D. Davis, M. Evans, A. Jadad, L. Perrier, D. Rath, D. Ryan, G. Sibbald, S. Straus, S. Rappolt, M. Wowk, et al. The case for knowledge translation: shortening the journey from evidence to effect BMJ, July 3, 2003; 327(7405): 33 - 35. [Full Text] [PDF]

				S. Yusuf and G. Dagenais More than just hype Can. Med. Assoc. J., June 24, 2003; 168(13): 1646 - 1646. [Full Text] [PDF]

				W. Shishkov More than just hype Can. Med. Assoc. J., June 24, 2003; 168(13): 1647 - 1647. [Full Text] [PDF]

				L. Pilote More than just hype Can. Med. Assoc. J., June 24, 2003; 168(13): 1647 - 1648. [Full Text] [PDF]

				Minerva BMJ, March 15, 2003; 326(7389): 608 - 608. [Full Text] [PDF]

				L. Pilote Ramipril use in Canada: HOPE or HYPE? Can. Med. Assoc. J., March 4, 2003; 168(5): 568 - 569. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2003, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.