The HOPE (Heart Outcome Prevention Evaluation) study was designed to test the hypotheses that two preventative intervention strategies, namely ACE inhibition or vitamin E would improve morbidity and mortality in high risk patients compared with placebo.The initial three papers from the HOPE investigators were published recently in the New England Journal of Medicine and the Lancet. The NEJM articles describe the main results of the Vitamin E and ACE inhibitor (ramipril) arms of the study, while the Lancet article (MicroHOPE) describes the results of these interventions in the large diabetic sub-population in HOPE. This review addresses the results of the ACE inhibitor arm of the study, both on the trial population as a whole and on the large diabetic subgroup.