February 5th, 2013

ACE Inhibitor Improves Walking in People with Peripheral Artery Disease

Giving an ACE inhibitor to people with peripheral artery disease (PAD) and intermittent claudication reduces pain and increases walking time, according to a new study published in JAMA. Currently the pharmacologic options for this patient population are few and have limited efficacy.

Researchers at three Australian hospitals randomized 212 patients with PAD to receive the ACE inhibitor ramipril or placebo for 24 weeks. Compared to the patients on placebo, patients on the ACE inhibitor had a mean 75-second increase in their pain-free walking time (156 seconds in the placebo group versus 229 seconds in the ramipril group, p<0.001) and a 255-second increase in their maximum walking time (259 seconds in the placebo group versus 512 seconds in the ramipril group, p<0.001).  The ACE inhibitor was also associated with improvements in other secondary measures of walking and physical quality of life.

The authors note that although the HOPE trial demonstrated that ramipril reduces cardiovascular events in PAD patients, ACE inhibitors are not “specifically recommended for the relief of intermittent claudication. To our knowledge, this is the first adequately powered randomized trial demonstrating that treatment with ramipril is associated with improved treadmill walking performance in patients with PAD.”

In an accompanying editorial, Mary McGrae McDermott writes that “given the paucity of effective therapies for treating functional limitation in PAD and recent randomized controlled clinical trials that have failed to demonstrate improved walking performance in response to novel medical therapies in PAD, the magnitude of improvement associated with ramipril… is particularly notable.” But, she observes, the results may not apply to other ACE inhibitors, and ramipril may not have the same efficacy in other PAD patient populations.

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