title: Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication.
abstract: OBJECTIVE
  The aim of this meta-analysis was to investigate the effect of angiotensin converting enzyme (ACE) inhibitors on maximum walking distance (MWD), pain-free walking distance (PFWD) and ankle brachial pressure index (ABPI) in patients with intermittent claudication (IC).
  
  
  METHODS
  MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to July 2013 on randomised controlled trials (RCTs) that assessed the effect of ACE inhibitors on MWD, PFWD and ABPI in patients with IC.
  
  
  RESULTS
  Of 348 publications found, a meta-analysis was conducted of 6 RCTs comprising 821 patients. Treatment with ACE inhibitors improved MWD by mean difference (95 per cent confidence interval) of 120.8 (2.95-238.68) m (P = 0.040), improved PFWD by 74.87 (25.24-124.50) m (P = 0.003) and insignificantly improved ABPI by 0.07 (-0.02-0.17) (P = 0.110) compared to placebo. Heterogeneity across studies was significant. Maximum treatment benefit was achieved after a 6-months treatment period with ramipril as the ACE inhibitor.
  
  
  CONCLUSIONS
  Treatment with ACE inhibitors improved walking ability in patients with IC. However, this was not associated with significant improvement in ABPI. Patients with IC might benefit from treatment with a high tissue affinity ACE inhibitor for a period of 6 months.
authors.affiliation: Academic Vascular Surgical Unit, Hull York Medical School and University of Hull, Hull, UK. Electronic address: yousef.shahin@yahoo.co.uk.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shahin
authors.forename: Rachel
authors.initials: R
authors.lastname: Barnes
authors.forename: Hashem
authors.initials: H
authors.lastname: Barakat
authors.forename: Ian C
authors.initials: IC
authors.lastname: Chetter
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000842:Ankle / Q000473:pathology*; D055109:Ankle Brachial Index; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D016138:Walking
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin converting enzyme inhibitors; Ankle brachial pressure index; Intermittent claudication; Peripheral arterial disease; Walking distance