ACE inhibitor enhances pain-free walking and physical functioning in patients with peripheral artery disease

Taken from the Journal of the American Medical Association (JAMA) – by Bruce Sylvester – Patients experiencing intermittent claudication, pain in the calf while walking, who were treated for 24 weeks with the angiotensin-converting enzyme (ACE) inhibitor ramipril  achieved improvements in pain-free and maximum walking times and improvements in the physical health aspect of quality of life, researchers reported in the February 6 issue of JAMA.

“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,” said lead author Anna A. Ahimastos, Ph.D., of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

The authors noted that about 27 million individuals in Europe and North America have peripheral artery disease (PAD), with intermittent claudication occurring  in approximately one-third of patients. The condition can cause functional disability. Treatment   is aimed at reducing cardiovascular risk, increasing functional performance, and improving health-related quality of life. Current treatments directed at  improving walking distance have shown benefits.

The investigators enrolled 212 subjects in this randomized, placebo-controlled trial. All were diagnosed with peripheral artery disease (average age, 65.5 years). They were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks.

Primary outcomes were the maximum and pain-free walking times. The researchers used The Walking Impairment Questionnaire (WIQ) to evaluate walking ability and the Short-Form 36 Health Survey (SF-36) to evaluate quality of life.

They reported that, compared to placebo subjects, ramipril subjects achieved a 75-second increase in average pain-free walking time and a 255-second increase in maximum walking time (a 77 percent and 123 percent increase in pain-free and maximum walking times, respectively).

Compared to placebo, ramipril subjects also achieved greater improvements in WIQ scores (median distance, speed score and stair climbing) overall SF-36 median Physical Component Summary score.

“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 wrote.

Mary McGrae McDermott, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, commented on the results of this study in an accompanying JAMA editorial.

“A recent report from the Global Disease Burden study concluded that global disease burden continues to shift away from communicable to non-communicable diseases and from premature death to greater years lived with disability. New therapies are needed to improve mobility and reduce disability among men and women living with PAD and other chronic diseases. Further study is needed to confirm the findings reported by Ahimastos et al and to determine whether ramipril therapy and other ACE inhibitors improve walking performance in ethnically diverse populations.”