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Currently, medical therapy is limited for patients with peripheral arterial disease (PAD) and intermittent claudication. To assess whether the angiotensin-converting–enzyme (ACE) inhibitor ramipril improves ambulatory function in PAD patients, researchers conducted a trial in which walking times on a treadmill and other measures of function were compared in 212 Australian PAD patients (mostly men; mean age, 65.5) who were randomized to daily ramipril (10 mg) or placebo for 6 months.
All patients underwent treadmill testing at baseline and at the end of the trial. At 6 months, pain-free and maximum walking times were 75 seconds and 225 seconds longer, respectively, in the ramipril group than in the placebo group. Ramipril recipients also reported greater improvements in walking distance, walking speed, stair climbing, and physical health–related quality of life.
Ahimastos AA et al. Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: A randomized controlled trial. JAMA 2013 Feb 6; 309:453. (http://dx.doi.org/10.1001/jama.2012.216237)
McDermott MM. Medications for improving walking performance in peripheral artery disease: Still miles to go. JAMA 2013 Feb 6; 309:487. (http://dx.doi.org/10.1001/jama.2013.89)
Comment
In this trial, ramipril improved walking ability and quality of life in PAD patients with intermittent claudication. Prior small studies of ACE inhibitors have yielded mixed results, but this is the largest study to date. How ACE inhibitors improve walking ability is unclear, but the authors postulate several mechanisms, including vasodilation, improved endothelial function, and changes in skeletal muscle structure and function. An editorialist cautions that these findings should be replicated in more ethnically diverse cohorts (and in women), but, given the limited arsenal of treatments currently available, these data are good news for patients suffering from PAD.