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Topic: Ramipril

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	Ramipril - Wikipedia, the free encyclopedia
		Ramipril (marketed as Tritace® or Altace®) is an angiotensin converting enzyme (ACE) inhibitor, used to treat high blood pressure and congestive heart failure.
		ACE inhibitors lower the production of Angiotensin II, therefore relaxing arterial muscles while at the same time enlarging the arteries, allowing the heart to pump blood easier, and increasing blood flow due to more blood being pumped into and through bigger passageways.
		The half-life of ramiprilat is variable (3 - 16 hours), and is prolonged by heart and liver failure, as well as kidney failure.
	en.wikipedia.org /wiki/Ramipril (130 words)

	ACC Clinical Trials
		The ramipril arm was terminated early because of clear reductions in the primary endpoint among patients treated with this agent.
		The incidence of the composite endpoint was 13.9% in the ramipril group and 17.5% in the placebo (a relative risk reduction of 22%).
		Thus, it may be that ramipril exerts a protective effect on the vascular that is mediated through its mechanism of ACE inhibition.
	www.acc.org /education/online/trials/esc99/hope.htm (443 words)

	MedlinePlus Drug Information: Ramipril
		Ramipril is used alone or in combination with other medications to treat high blood pressure.
		It is also used to reduce the risk of heart attack and stroke in patients at risk for these problems and to improve survival in patients with heart failure after a heart attack.
		Ramipril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors.
	www.nlm.nih.gov /medlineplus/druginfo/medmaster/a692027.html (857 words)

	Ramipril in Feline Cardiomyopathy - WSAVA 2002
		Ramipril treatment was combined with thyrostatic treatment (carbimazole) in cats suffering from hyperthyroidism, and both drugs proved to be effective and did not produce side effects.
		The dose rate of ramipril recommended for dogs (0.125 mg ramipril/kg once daily) proved to be adequate in most cases and improved the clinical signs in the cats in the present study.
		Ramipril treatment not only appeared to be safe in combination with the loop diuretic furosemide but also with the thyrostatic drug carbimazole and with ß-methyldigoxin in the cats in the present study.
	www.vin.com /proceedings/Proceedings.plx?CID=WSAVA2002&PID=2800 (619 words)

	The Angiotensin-Converting Enzyme Inhibitor Ramipril Is Found to Prevent Cardiovascular Events in Diabetes Patients ...
		Ramipril also reduced the individual risks for each of the three components of the primary outcome, with a 37% risk reduction in cardiovascular death, a 22% risk reduction in myocardial infarction, and a 33% risk reduction in stroke.
		To address the possibility that the effect of ramipril was due to its well-known blood pressure–lowering effect, the researchers controlled for change in blood pressure during the study and found that ramipril still reduced the risk of the primary outcome by 25%.
		Ramipril was found to significantly reduce the risk of nephropathy (as defined by an albumin-creatinine ratio >36 mg/mmol) by 22% (P=0.045), and overt nephropathy, laser therapy for diabetic retinal disease, or renal dialysis by 15% (P=0.05).
	www.ndei.org /v2/website/litalerts/article.cfm?article_id=115 (506 words)

	Ramipril - Diabetes Mellitus, Type 2, Type 1, and Metabolic Disorders treatment and medications
		Ramipril also seems to be the first drug known to prevent the onset of diabetes.
		Ramipril was found to cut the risk of death from cardiovascular disease by 25%, heart attack by 20%, and stroke by more than 30%.
		Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on death from cardiovascular causes, myocardial infarction, and stroke in high-risk patients.
	www.medicinenet.com /script/main/art.asp?articlekey=11075 (719 words)

	Altace Online, Description, Chemistry, Ingredients - Ramipril - RxList Monographs (Site not responding. Last check: 2007-11-02)
		Ramipril melts between 105°C and 112°C. The CAS Registry Number is 87333-19-5.
		Ramipril is converted to ramiprilat by hepatic cleavage of the ester group.
		Altace (ramipril) is supplied as hard shell capsules for oral administration containing 1.25 mg, 2.5 mg, 5 mg, and 10 mg of ramipril.
	www.rxlist.com /cgi/generic/ramipril.htm (224 words)

	Online NewsHour: Hope for the Heart -- November 11, 1999
		Ramipril, widely used to lower blood pressure, may also be successful in preventing heart attacks and diabetes.
		The study found that Ramipril cut deaths from heart disease by 22 percent, reduced heart attacks by more than 20 percent, cut new diabetes cases by 30 percent and resulted in 14 percent fewer coronary artery bypass operations.
		So right now, Ramipril is the drug that appears to be the one that would be the agent in focus for treating patients such as these.
	www.pbs.org /newshour/bb/health/july-dec99/heart_11-11.html (1154 words)

	Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus:
		Ramipril lowered the risk of the combined primary outcome by 25% (95% CI 1236, p=0·0004), myocardial infarction by 22% (636), stroke by 33% (1050), cardiovascular death by 37% (2151), total mortality by 24% (837), revascularisation by 17% (230), and overt nephropathy by 24% (340, p=0·027).
		Ramipril's benefit was noted irrespective of whether participants had a history of cardiovascular events (p for interaction=0·91), hypertension (p for interaction=0·93), or microalbuminuria (p for interaction=0·34), whether or not participants had type 1 or type 2 diabetes (p for interaction=0·32), and irrespective of current treatment for hyperglycaemia (p for interaction=0·51).
		The effect of ramipril on a reported history of new laser therapy for diabetic retinopathy, and on a reported history of renal dialysis are shown in table 3.
	www.diabetes-mellitus.org /hope.htm (4618 words)

	Ramipril and cardiovascular events in high risk patients (HOPE)
		The percentage of patients assigned to ramipril actually receiving 10 mg of ramipril was 83% at one year follow-up and 65% at the final visit.
		At the end of the study it was 136/76 in the ramipril group and 139/77 in the placebo group.
		Among 244 patients assigned to high dose (10 mg) ramipril, 12.7% reached the composite endpoint; among 244 assigned to low-dose (2.5 mg) ramipril, 13.9% reached the endpoint and among 244 assigned to placebo 16.8% reached the endpoint.
	www.journalclub.org /vol2/a73.html (2335 words)

	Prescribing Information : Altace ® (Ramipril)
		Ramipril is almost completely metabolized to ramiprilat, which has about 6 times the ACE inhibitory activity of ramipril, and to the diketopiperazine ester, the diketopiperazine acid, and the glucuronides of ramipril and ramiprilat, all of which are inactive.
		Ramipril is indicated in stable patients who have demonstrated clinical signs of congestive heart failure within the first few days after sustaining acute myocardial infarction.
		Administration of ramipril to such patients has been shown to decrease the risk of death (principally cardiovascular death) and to decrease the risks of failure-related hospitalization and progression to severe/resistant heart failure.
	www.vidyya.com /archives/1007_4.htm (5881 words)

	Ramipril (Site not responding. Last check: 2007-11-02)
		Ramipril may pass into breast milk; caution is advised.
		Ramipril should be used with caution by patients with severe kidney disease or renal artery stenosis (narrowing of one or both of the arteries that supply blood to the kidneys).
		Fever and chills, sore throat and hoarseness, sudden difficulty breathing or swallowing, swelling of the face, mouth, or extremities, impaired kidney function (ankle swelling, decreased urination), confusion, yellow discoloration of the eyes or skin (indicating liver disorder), intense itching, chest pain or palpitations, abdominal pain.
	www.wholehealthmd.com /refshelf/drugs_view/1,1524,542,00.html (610 words)

	ramipril Consumer Drug Information
		Ramipril is used to treat hypertension (high blood pressure), to prevent heart failure following a heart attack, and to reduce the risk of heart attack, stroke, and death in patients who are at an increased risk for these problems.
		Ramipril is in the FDA pregnancy category D. This means that ramipril is known to harm an unborn baby.
		Ramipril passes into breast milk and its effects on a nursing baby are not known.
	www.drugs.com /MTM/ramipril.html (1285 words)

	Prolonged use of ramipril prevents stroke (Site not responding. Last check: 2007-11-02)
		Patients who are at high risk of stroke should be treated with the drug ramipril, irrespective of their initial blood pressure levels and in addition to other preventive treatments such as blood pressure lowering agents or aspirin, finds a study in this week’s BMJ.
		The risk of fatal stroke was reduced by 61% and significantly fewer patients on ramipril had mental or functional impairment.
		Widespread use of a drug such as ramipril in patients at high risk of stroke is likely to have a major impact on public health, they conclude.
	www.eurekalert.org /pub_releases/2002-03/bmj-puo032002.php (240 words)

	Effect Of Ramipril On Non-Diabetic Proteinuric Nephropathy (Site not responding. Last check: 2007-11-02)
		Both in the GFRD-based or events-based models, ramipril delayed progression to ESRD and prolonged patient survival by 1.5 to 2.2 and 1.2 to 1.4 years, respectively, and saved $16,605 to $23,894 lifetime and $2,422 to $4203 yearly direct costs per patient.
		It was concluded that ramipril prolongs life while saving money because of its beneficial effect on the course of non-diabetic chronic nephropathies.
		Ramipril prolongs life and is cost effective in chronic proteinuric nephropathies.
	www.indegene.com /Nep/Jour/indJour_KI_Sum_01-01-2001_4.asp (366 words)

	Ramipril - Patient UK
		Ramipril works by causing blood vessels to relax, lowering blood pressure and increasing the supply of blood and oxygen to the heart.
		Ramipril is available in capsule and tablet form.
		Ramipril may cause drowsiness, dizziness or lightheadedness, especially the first time you take it.
	www.patient.co.uk /showdoc/30002360 (836 words)

	Altace - Drugs & Vitamins - Drug Library - DrugDigest
		Ramipril controls high blood pressure (hypertension) by relaxing blood vessels; it is not a cure.
		Do not treat yourself for a fever or sore throat; check with your prescriber or health care professional as these may be the result of a ramipril side effect.
		Do not treat yourself for coughs, colds, or pain while you are using ramipril without asking your prescriber or health care professional for advice.
	www.drugdigest.org /DD/DVH/Uses/0,3915,585\|Altace,00.html (739 words)

	Altace (Ramipril) Reverses Heart Enlargement/Cuts Cardiovascular Risk (Site not responding. Last check: 2007-11-02)
		In this HOPE sub-study, researchers examined the electrocardiograms (ECG) of 8,281 patients at the beginning and end of the four-and-a-half-year study, comparing the prevalence, regression or development of LVH, together with patient outcomes such as heart attacks, stroke and heart failure.
		The full HOPE trial compared the effects of ramipril in addition to standard therapy, with placebo and vitamin E in about 9,500 patients at high risk for cardiovascular events.
		Results announced in 1999, showed ramipril reduced the risk of cardiovascular deaths by 25 percent, heart attack by 20 percent, and stroke by 32 percent, Dr. Mathew reports.
	www.pslgroup.com /dg/207A22.htm (791 words)

	Ramipril (Site not responding. Last check: 2007-11-02)
		Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, a family of drugs used to treat high blood pressure and some types of heart failure.
		While zinc depletion has not been reported with ramipril, until more is known, it makes sense for people taking ramipril long term to consider, as a precaution, taking a zinc supplement or a multimineral tablet containing zinc.
		In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.
	www.kroger.com /hn/Drug/Ramipril.htm (662 words)

	Use of ramipril in preventing stroke: double blind randomised trial -- Bosch et al. 324 (7339): 699 -- BMJ (Site not responding. Last check: 2007-11-02)
		Ramipril, an angiotensin converting enzyme inhibitor, reduces strokes in patients at high risk whose blood pressure is not elevated, despite only a modest lowering of blood pressure
		Impact of ramipril on stroke subdivided by non-fatal and fatal stroke, subtype of stroke, and presence or absence of functional impairment.
		The relative risk of developing stroke in the ramipril group compared with the placebo group was 0.68 (95% confidence interval 0.56 to 0.84; P=0.0002).
	bmj.bmjjournals.com /cgi/content/abridged/324/7339/699 (2961 words)

	News - Ramipril Reduces Advanced Glycation End Products In Non-Diabetic Nephropathy
		Ramipril produces a mild reduction in levels of advanced glycation end products, perhaps reflecting decreased oxidative stress, in patients with mild-to-moderate non-diabetic nephropathy.
		Ramipril reduced blood pressure and proteinuria, while creatinine clearance did not alter.
		Ramipril also mildly decreased levels of advanced glycation end products, while concentrations of advanced oxidation protein products and malondialdehyde declined.
	www.docguide.com /news/content.nsf/news/8525697700573E1885256D0A002D53EA (451 words)

	Ramipril use in Canada (Site not responding. Last check: 2007-11-02)
		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.
		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.
		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.
	www.eurekalert.org /pub_releases/2003-03/cmaj-rui022803.php (247 words)

	Cost effectiveness of ramipril treatment for cardiovascular risk reduction -- Malik et al. 85 (5): 539 -- Heart (Site not responding. Last check: 2007-11-02)
		Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk,
		Ramipril treatment within the medium risk group (the HOPE population) had a five year undiscounted cost effectiveness of £13
		Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure.
	heart.bmjjournals.com /cgi/content/full/85/5/539 (3037 words)

	Good Long-Term Results For Patients On Ramipril After Heart Attack (Site not responding. Last check: 2007-11-02)
		Ramipril is an angiotensin-converting-enzyme (ACE) inhibitor that prevents constriction of blood vessels and aids circulation.
		By March 1, 1996, death from all causes had occurred in 117 (38.9%) of the 301 patients randomly assigned placebo and in 83 (27.5%) of 302 patients randomly assigned ramipril; an absolute reduction in mortality of 11.4% (114 additional 5-year survivors per 1000 patients treated for an average of 12.4 months).
		The authors concluded that "administration of ramipril to patients with clinically defined heart failure after AMI results in a survival benefit that is not only large in magnitude, but also sustained over many years".
	www.pslgroup.com /dg/2983E.htm (453 words)

	Business Wire: Ramipril Comprehensive: Biovail Reports Positiv... @ HighBeam Research (Site not responding. Last check: 2007-11-02)
		In this study, both G-99 and ramipril were dosed in the evening.
		The starting dose of G-99 was 240mg once-daily in the evening while for ramipril the starting dose was 5mg once-daily in the evening.
		Adverse events were consistent with the approved package insert for ramipril and the pending package insert for G-99.
	www.highbeam.com /library/doc0.asp?DOCID=1G1:93514611&refid=holomed_1 (652 words)

	News - Significant Stroke Prevention Noted With Ramipril
		Patients at high risk of stroke should be treated with the ACE inhibitor ramipril, trials at 267 hospitals in 19 countries has shown.
		Dr Bosch found, in the trial, that while there was a modest reduction in blood pressure, the risk of any stroke was reduced by 32 percent in the ramipril cohort compared with the placebo group.
		Benefits of ramipril are consistent in patients with and without previous stroke, previous manifestation of any cerebrovascular disease, coronary artery disease, peripheral arterial disease, or diabetes.
	www.docguide.com /news/content.nsf/news/8525697700573E1885256B84004E382D (572 words)

	Comparative Effects of Ramipril on Ambulatory and Office Blood Pressures: A HOPE Substudy -- Svensson et al. 38 (6): 28 ...
		OBP at baseline was 152±21/83±7 mm Hg and 149±19/79±12 mm Hg (P=NS) in the ramipril
		Hourly means of systolic and diastolic ABP in the ramipril group (A, n=20) and placebo group (B, n=18) at baseline and 1 year.
		The design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events: The HOPE study investigators.
	hyper.ahajournals.org /cgi/content/full/38/6/e28 (2780 words)

	Hypertension Online Slides - ace, REIN, Ramipril Efficacy in Nephropathy Study
		The Ramipril Efficacy In Nephropathy (REIN) study is the second clinical trial to confirm that ACE inhibitors have a similar action in patients with chronic non-diabetic nephropathies.
		In chronic nephropathies with proteinuria of =3 grams/24 hrs, ramipril safely reduces proteinuria and the rate of GFR decline to an extent that seems to exceed the reduction expected for the degree of blood- pressure lowering.
		Among the ramipril-assigned patients, percentage reduction in proteinuria was inversely correlated with decline in GFR (P=0.035) and predicted the reduction in risk of doubling of baseline creatinine or end stage renal failure (18 ramipril vs 40 placebo, P=0.04).
	www.hypertensiononline.org /slides2/slide01.cfm?q=ace&dpg=22 (286 words)

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