Ramipril increases pain-free walking time in patients with peripheral artery disease

Feb 5^th – JAMA – Pain-free walking time and maximum walking times increased by 77% and 123%, respectively with the use of ramipril in peripheral artery disease.

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1. At six months of therapy, pain-free walking time and maximum walking times increased by 77% and 123%, respectively with the use of ramipril.

2. In associated surveys, patients on ramipril noted improvements of perceived ability to perform daily activities.

The study indicates that ramipril, in comparison with placebo, significantly increased pain-free walking time and maximum walking times. These results are especially important because claudication is known to greatly affect quality of life and increase hospitalization rates for those with peripheral artery disease (PAD).

This study is strengthened by its double-blind, randomized placebo-controlled design, as well as a relatively large sample size. Bolstering its potential importance, the improvement seen with ramipril was greater than improvement rates on existing FDA-approved medications (e.g. cilostazol and pentoxifylline), which is very encouraging although the study was not designed to make such comparisons. Nonetheless, a few limitations should be considered for this study. First, this study was conducted solely on Australian patients with strict inclusion criteria, hindering its generalizability. Secondly, there is no proven biochemical explanation for the results, which should be a subject of future research. Nonetheless, the study provides solid support for the use of ACE inhibitors, specifically ramipril, for patients with PAD.

Click to read the study in JAMA

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1. At six months of therapy, pain-free walking time and maximum walking times increased by 77% and 123%, respectively with the use of ramipril.

2. In associated surveys, patients on ramipril noted improvements of perceived ability to perform daily activities.

This [randomized, double-blind, placebo-controlled] study: The study followed 212 Australian participants (mean age 65.5) from three hospitals for three years. The participants were divided into two groups: ramipril 10 mg/d for 24 weeks or placebo. Compared to the placebo group, those on ramipril demonstrated a 75-second increase in mean pain-free walking time. Ramipril also increased maximum walking time by 255 seconds. Furthermore, the ramipril group reported improvements in Walking Impairment Questionnaire scores, which served as a proxy to patient’s perception of the severity of their physical impairments.

In sum: The study indicates that ramipril, in comparison with placebo, significantly increased pain-free walking time and maximum walking times. These results are especially important because claudication is known to greatly affect quality of life and increase hospitalization rates for those with peripheral artery disease (PAD).

This study is strengthened by its double-blind, randomized placebo-controlled design, as well as a relatively large sample size. Bolstering its potential importance, the improvement seen with ramipril was greater than improvement rates on existing FDA-approved medications (e.g. cilostazol and pentoxifylline), which is very encouraging although the study was not designed to make such comparisons. Nonetheless, a few limitations should be considered for this study. First, this study was conducted solely on Australian patients with strict inclusion criteria, hindering its generalizability. Secondly, there is no proven biochemical explanation for the results, which should be a subject of future research. Nonetheless, the study provides solid support for the use of ACE inhibitors, specifically ramipril, for patients with PAD.

Click to read the study in JAMA 

By John Prendergass and Rif Rahman

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