Results : BP and lipid levels tended to come together soon in the post-trial period .
Conclusion : Benefits of BPL and lipid lowering on all-cause and cardiovascular mortality were persistent , but attenuated , after discontinuation of r and omized treatment , indicating the importance of continuing therapy
Objective : Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment .
We conducted a systematic review to assess the long-term effects of  blood pressure ( BP ) lowering ( BPL ) and lipid lowering on all-cause and cardiovascular mortality after discontinuation of r and omized treatment .
Long-Term Effects of Ramipril on Cardiovascular Events and on Diabetes: Results of the HOPE Study Extension
Background —We have previously demonstrated that ramipril reduces vascular events and new diagnoses of diabetes when given for a 4.5-year period . However , it is not known whether the benefits are observed in subgroups of patients at varying risk or on other proven therapies and whether the benefits are sustained beyond the current trial . The 2 aims of this investigation were to assess whether the benefits observed during the HOPE trial were ( 1 ) maintained after trial cessation during an additional 2.6 years of follow-up and ( 2 ) observed in subgroups based on risk and ancillary treatments . Methods and Results —Of the initial 267 study centers and 9297 patients , 174 centers and 4528 patients agreed to further follow-up . The rates of use of angiotensin-converting-enzyme inhibitors ( ACEIs ) in the 2 groups ( 72 % ramipril versus 68 % placebo ) were similar after the end of the trial . During the posttrial follow-up , patients allocated to ramipril had a 19 % further lower relative risk ( RR ) of myocardial infa rct ion ( 95 % confidence interval [ CI ] , 0.65 to 1.01 ) , a 16 % lower RR ( 95 % CI , 0.70 to 0.99 ) of revascularization , and a 34 % lower RR of a new diagnosis of diabetes ( 95 % CI , 0.46 to 0.95 ) . Similar RR reductions in vascular events were observed during and after the active phase of the trial , regardless of baseline risk ( RR of 0.76 , 0.89 , and 0.83 for low- , medium- , and high-risk patients , respectively ) or ancillary treatments ( RR of 0.90 for aspirin , 0.76 for & bgr;-blockers , and 0.84 for lipid-lowering medication ) . Conclusions —The benefits of ramipril observed during the active period of the HOPE trial were maintained during posttrial follow-up for cardiovascular death , stroke , and hospitalization for heart failure . Additional reductions in myocardial infa rct ion , revascularization , and the development of diabetes were observed during the follow-up phase despite similar rates of ACEI use in the 2 r and omized groups . These benefits were consistent regardless of patient risk or ancillary treatments
Results : BP and lipid levels tended to come together soon in the post-trial period .
Conclusion : Benefits of BPL and lipid lowering on all-cause and cardiovascular mortality were persistent , but attenuated , after discontinuation of r and omized treatment , indicating the importance of continuing therapy
Objective : Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment .
We conducted a systematic review to assess the long-term effects of  blood pressure ( BP ) lowering ( BPL ) and lipid lowering on all-cause and cardiovascular mortality after discontinuation of r and omized treatment .