title: Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease.
abstract: OBJECTIVE
  The aim of this study was to assess the prognostic importance of peripheral arterial disease (PAD) as evaluated by ankle blood pressure index (ABI), and the impact of ramipril on the prevention of major cardiovascular events in PAD patients included in the Heart Outcomes Prevention Evaluation (HOPE) study.
  
  
  RESULTS
  Patients were randomized to treatment with ramipril or placebo and followed for 4.5 years. Ankle brachial blood pressure index was measured, mainly by digital palpation of the foot pulse, at baseline in 8986 patients. The ABI was subnormal (< or =0.9) in 3099 patients and normal in 5887 patients. A low ABI was a strong predictor of morbidity and mortality during the follow-up even in patients with no clinical symptoms of PAD (n=6769). This was so for the primary outcome of the study; ABI>0.9:13.1%, 0.6-0.9: 18.2% and <0.6: 18.0% (P<0.0001) and for mortality from all causes: in those with a normal ABI it was 8.5%, in those with ABI >0.6-0.9, 12.4% and 14.2% in those with an ABI lower than 0.6 (P<0.0001). Ramipril reduced the risk of clinical outcomes in those with a clinical history of PAD as well as in the patients with subclinical PAD.
  
  
  CONCLUSIONS
  The ABI even if measured simply by palpation of the foot arteries is a strong predictor for future cardiovascular events and for all-cause mortality. Ramipril prevented major cardiovascular events in patients with clinical as well as subclinical PAD.
authors.affiliation: Department of Medicine, Division of Emergency Medicine, Karolinska Hospital, 171 76 Stockholm, Sweden. jan.ostergren@ks.se
authors.forename: J
authors.initials: J
authors.lastname: Ostergren
authors.forename: P
authors.initials: P
authors.lastname: Sleight
authors.forename: G
authors.initials: G
authors.lastname: Dagenais
authors.forename: K
authors.initials: K
authors.lastname: Danisa
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.forename: Yi
authors.initials: Y
authors.lastname: Qilong
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000842:Ankle / Q000098:blood supply; D001158:Arteries; D001794:Blood Pressure; D001916:Brachial Artery / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000503:physiopathology; D017257:Ramipril / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril