In the Heart Outcomes Prevention Evaluation (HOPE) Study, diabetic patients randomized to ramipril had a 24% risk reduction compared with diabetic patients randomized to placebo. A similar risk reduction was seen in the nondiabetic patients randomized to active therapy. Patients with diabetes in the HOPE Trial required only one additional risk factor for inclusion. These data suggest that ramipril, a tissue-specific ACE inhibitor, may provide cardiovascular protection in diabetic patients with associated risk factors even in the absence of a prior history of cardiovascular disease or a diagnosis of hypertension.
Reference:

Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-153.