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The cardiovascular risk associated with early renal insufficiency is unknown. Clinicians are often reluctant to use angiotensin-converting enzyme inhibitors in patients with renal insufficiency.

To determine whether mild renal insufficiency increases cardiovascular risk and whether ramipril decreases that risk.

Post hoc analysis.

The Heart Outcomes and Prevention Evaluation (HOPE) study, a randomized, double-blind, multinational trial involving 267 study centers.

980 patients with mild renal insufficiency (serum creatinine concentration ≥ 124 µmol/L [≥ 1.4 mg/dL]) and 8307 patients with normal renal function (serum creatinine concentration < 124 µmol/L [<1.4 mg/dL]) Patients with a baseline serum creatinine concentration …