Effect of Ramipril on Walking Times and Quality of Life Among Patients With Peripheral Artery Disease and Intermittent Claudication: A Randomized Controlled Trial

Study Questions:

What is the impact of ramipril therapy on walking time in patients with peripheral artery disease (PAD)?


The authors randomized 212 patients with PAD and stable claudication to 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks. The main outcome measures were maximum and pain-free walking times during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short Form-36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively.


Ramipril was associated with an increase of 75 seconds (95% confidence interval [CI], 60-89 seconds) in mean pain-free walking time (p < 0.001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (p < 0.001). Ramipril improved the WIQ median distance score by 13.8, speed score by 13.3, and stair climbing score by 25.2 (p < 0.001 for all). The overall SF-36 Physical Component Summary score improved by 8.2 in the ramipril group relative to placebo.


The authors concluded that ramipril was associated with a significant improvement in pain-free and maximum treadmill walking times.


The magnitude of benefit associated with ramipril in this study exceeds that seen with any other medical therapy in patients with PAD (including that seen with cilostazol). The benefit of optimal risk factor control in patients with PAD has been demonstrated in many observational studies (see Ardati et al., Circ Cardiovasc Interv 2012;5:850-5), and consideration should be given to including angiotensin-coverting enzyme inhibition as an essential part of medical therapy for patients with symptomatic PAD.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Outcome Assessment (Health Care), Walking, Movement Disorders, Peripheral Arterial Disease, Risk Factors, Pain, Tetrazoles, Peripheral Vascular Diseases, Exercise Test

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