title: Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial.
abstract: OBJECTIVE
  Approximately one-third of patients with peripheral artery disease experience intermittent claudication, with consequent loss of quality of life.
  
  
  OBJECTIVE
  To determine the efficacy of ramipril for improving walking ability, patient-perceived walking performance, and quality of life in patients with claudication.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial conducted among 212 patients with peripheral artery disease (mean age, 65.5 [SD, 6.2] years), initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia.
  
  
  METHODS
  Patients were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks.
  
  
  METHODS
  Maximum and pain-free walking times were recorded during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively.
  
  
  RESULTS
  At 6 months, relative to placebo, ramipril was associated with a 75-second (95% CI, 60-89 seconds) increase in mean pain-free walking time (P < .001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (P < .001). Relative to placebo, ramipril improved the WIQ median distance score by 13.8 (Hodges-Lehmann 95% CI, 12.2-15.5), speed score by 13.3 (95% CI, 11.9-15.2), and stair climbing score by 25.2 (95% CI, 25.1-29.4) (P < .001 for all). The overall SF-36 median Physical Component Summary score improved by 8.2 (Hodges-Lehmann 95% CI, 3.6-11.4; P = .02) in the ramipril group relative to placebo. Ramipril did not affect the overall SF-36 median Mental Component Summary score.
  
  
  CONCLUSIONS
  Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00681226.
authors: Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Rd Central, Melbourne, Victoria, 8008 Australia. a.ahimastos@alfred.org.au
authors: Anna A
authors: AA
authors: Ahimastos
authors: Philip J
authors: PJ
authors: Walker
authors: Christopher
authors: C
authors: Askew
authors: Anthony
authors: A
authors: Leicht
authors: Elise
authors: E
authors: Pappas
authors: Peter
authors: P
authors: Blombery
authors: Christopher M
authors: CM
authors: Reid
authors: Jonathan
authors: J
authors: Golledge
authors: Bronwyn A
authors: BA
authors: Kingwell
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D017257:Ramipril / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016138:Walking
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril