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

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

A Randomized Trial

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

Abstract

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.

Article and Author Information

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.