Ramipril Improves Walking For People With Peripheral Artery Disease

Editor's Choice
Academic Journal
Main Category: Vascular
Also Included In: Cardiovascular / Cardiology;  Pain / Anesthetics
Article Date: 06 Feb 2013 - 10:00 PST


Pain-free walking as well as length of walk both improved greatly in patients with claudication following treatment with the ACE blocker ramipril.

The new study, published in JAMA, revealed pain-free walking rose by 60 percent on average and maximum walking time doubled following six months of treatment with the ACE inhibitor.

Close to every secondary result also improved with ramipril versus placebo, such as functional areas of health-related quality of life and the ankle-brachial index (ABI) - an impairment scale for peripheral arterial disease (PAD).

An estimated 27 million people in North American and Europe have peripheral artery disease (PAD). PAD is characterized by obstruction of large arteries not within the brain, coronary, or aortic arch vascular.

Symptoms of PAD include:

• claudication - numbness, weakness, pain, or cramping in muscles because of decreased blood flow.
• Wounds, ulcers, or sores that don't heal.
• Change in color (blueness or paleness), cool temperature, when compared with other limb.
• Lack of hair and nail growth on affected limb.

Patients with claudication have significant difficulties with walking, causing functional disability and limitations in lifestyle.

Treatment of these patients generally includes decreasing cardiovascular risk, improving quality of life, and increasing functional performance. However, walking distance improvement drugs do not have a high success rate.

Ramipril Proves Successful

In order to measure the association of ramipril therapy on walking distance and health-related quality of life compared with placebo in people with PAD, Anna A. Ahimastos, Ph.D., of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia, and her co-workers conducted a randomized, placebo-controlled study.

The trial consisted of 212 patients with PAD with an average age of 65.5 years, starting in 2008 and ending in 2011.

The participants were randomly given ramipril or matching placebo for 24 weeks. The researchers analyzed maximum and pain-free walking times using a standard treadmill test. To assess walking ability and quality of life, they used the Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36).

In the ramipril group, at baseline (at the start of the trial), the mean pain-free walking time was 140.3 seconds, and 144.2 seconds in the placebo group. The average maximum walking time was 233.6 seconds in the ramipril group and 238.4 seconds in the placebo group. At the end of the study, ramipril was clearly significantly superior to placebo.

Ramipril was linked with a 77 percent increase in pain-free walking and a 123 percent increase in maximum walking times.

Additionally it was associated with improvements in WIQ scores and the total SF-36 median Physical Component Summary score. Limiting-leg ABI at rest averaged 0.57 and 0.55 after exercise.

The authors conclude:

"The increase in WIQ scores suggests that ramipril improves patient-perceived ability to perform normal daily activities. Ramipril therapy was also associated with moderate improvement in the physical health component of the SF-36 score. Importantly, these associations were additional to those achieved with standard clinical management by a general practitioner or vascular specialist.

Further benefits may be achieved by adherence to lifestyle recommendations including smoking cessation and regular exercise, as well as more aggressive medical management of cardiovascular risk factors."

The authors note that the current trial is the first randomized study that they know of showing that treatment with ramipril is linked with improved treadmill walking performance in patients with PAD.

A national study carried out in 2011 reported that exercise was shown to be more effective than stenting or medication for improved walking ability in patients with PAD.

Written by Kelly Fitzgerald
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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