Brief Communication: Ramipril Markedly Improves Walking Ability in Patients with Peripheral Arterial Disease

A Randomized Trial

2 May 2006 | Volume 144 Issue 9 | Pages 660-664

Background: Peripheral arterial disease (PAD) affects up to 12% of adults older than 50 years of age. Conventional therapies have only modest effects in improving symptoms.

Objective: To examine the effects of angiotensin-converting enzyme inhibition on walking ability in patients with PAD.

Design: Randomized, double-blind, placebo-controlled trial initiated in March 2003 and completed in January 2005.

Setting: The Alfred Hospital, Melbourne, Australia.

Participants: 40 older adults with symptomatic PAD and no history of diabetes or hypertension.

Intervention: 10 mg of ramipril (n = 20) or placebo (n = 20) once daily for 24 weeks. All patients completed the trial.

Measurements: Pain-free and maximum walking time were recorded during a standard treadmill test, and the standard Walking Impairment Questionnaire was administered.

Results: After adjustment for the baseline pain-free walking time, mean pain-free walking time after ramipril treatment was 227 seconds (95% CI, 175 seconds to 278 seconds; P < 0.001) longer than that after placebo treatment. Similarly, maximum walking time improved by 451 seconds in the ramipril group (CI, 367 seconds to 536 seconds; P < 0.001) but did not change in the placebo group. Ramipril improved the Walking Impairment Questionnaire median distance score from 5% (range, 1% to 39%) to 21% (range, 12% to 58%; P < 0.001), speed score from 3% (range, 3% to 39%) to 18% (range, 8% to 50%; P < 0.001), and stair-climbing score from 17% (range, 4% to 80%) to 67% (range, 38% to 88%; P < 0.001). No adverse events were reported.

Limitations: The sample size is modest, and the strict inclusion criteria limit the applicability of the results to patients with claudication and infrainguinal disease and those without diabetes.

Conclusion: Ramipril improved pain-free and maximum walking time in some adults with symptomatic PAD.

Editors' Notes Context Few therapies substantially reduce symptoms and improve exercise performance in patients with peripheral arterial disease (PAD). Contribution In this double-blind trial, investigators randomly assigned 40 older adults without diabetes and with symptomatic PAD to receive either ramipril or placebo, 10 mg once daily for 24 weeks. Compared with placebo, ramipril increased maximum and pain-free walking time and walking speed and distance. Cautions The trial was small and involved selected patients with limited mobility and exercise tolerance. Implications Ramipril may improve symptoms in some patients with PAD. —The Editors

 

Author and Article Information

From Baker Heart Research Institute, Alfred Hospital, and Monash University, Melbourne, Australia.

ClinicalTrials.gov identifier: NCT00168467.

Grant Support: By the National Health and Medical Research Council of Australia. Associate Professor Kingwell is a National Health and Medical Research Council of Australia senior research fellow.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Associate Professor Bronwyn A. Kingwell, PhD, Alfred and Baker Medical Unit, Baker Heart Research Institute, PO Box 6492, St. Kilda Road Central, Melbourne, Victoria, 8008 Australia; e-mail, b.kingwell{at}alfred.org.au.

Current Author Addresses: Ms. Ahimastos and Associate Professor Kingwell: Alfred and Baker Medical Unit, Baker Heart Research Institute, PO Box 6492, St. Kilda Road Central, Melbourne, Victoria 8008, Australia.

Mr. Lawler: 6th Floor Main Ward Block, Alfred Hospital, Central Commercial Road, Melbourne, Victoria 3004, Australia.

Associate Professor Reid: Centre of Clinical Research Excellence (CCRE) Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, 89 Commercial Road, Melbourne 3004, Australia.

Dr. Blombery: Heart Centre, 3rd Floor Philip Block, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.

Author Contributions: Conception and design: A.A. Ahimastos, P.A. Blombery, B.A. Kingwell.

Analysis and interpretation of the data: A.A. Ahimastos, A. Lawler, C.M. Reid, P.A. Blombery, B.A. Kingwell.

Drafting of the article: A.A. Ahimastos, P.A. Blombery, B.A. Kingwell.

Critical revision of the article for important intellectual content: A.A. Ahimastos, A. Lawler, C.M. Reid, P.A. Blombery, B.A. Kingwell.

Final approval of the article: A.A. Ahimastos, A. Lawler, C.M. Reid, P.A. Blombery, B.A. Kingwell.

Statistical expertise: C.M. Reid, B.A. Kingwell.

Obtaining of funding: P.A. Blombery, B.A. Kingwell.

Administrative, technical, or logistic support: A.A. Ahimastos, A. Lawler, P.A. Blombery, B.A. Kingwell.

Collection and assembly of data: A.A. Ahimastos, A. Lawler, P.A. Blombery, B.A. Kingwell.