Ramipril did not reduce incident diabetes in patients with impaired glycemic control.

M e t h o d s Design: Randomized placebo-controlled trial (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM]). Allocation: Concealed.* Blinding: Blinded (clinicians, patients, data collectors, and outcome assessors).* Follow-up period: Median 3 years. Setting: 191 centers in 21 countries. Patients: 5269 patients ≥ 30 years of age (mean age 55 y, 59% women) who had impaired fasting plasma glucose (≥ 110 mg/dL [6.1 mmol/L] but < 126 mg/dL [7.0 mmol/L]) or impaired glucose tolerance (plasma glucose level ≥ 140 mg/dL [7.8 mmol/L] but < 200 mg/dL [11.1 mmol/L] 2 h after oral glucose load). Exclusion criteria were history of diabetes (except gestational diabetes), CV disease, or intolerance to angiotensin-converting enzyme inhibitors or thiazolidinediones. Intervention: Ramipril, 5 mg/d for 2 months, then 10 mg/d for 10 months, and 15 mg/d after 1 year (n = 2623), or matching placebo (n = 2646). Outcomes: Composite endpoint of newly diagnosed diabetes or death. Secondary outcomes included a composite endpoint of CV events (myocardial infarction, stroke, CV death, heart failure, revascularization, newly diagnosed angina with evidence of ischemia, or ventricular arrhythmia requiring resuscitation) and regression to normoglycemia (fasting plasma glucose level < 110 mg/dL [6.1 mmol/L] and 2-h post-load glucose level < 140 mg/dL [7.8 mmol/L]). The study had 90% power to detect > 22% risk reduction in the ramipril group. Patient follow-up: 98% (intention-to-treat analysis).