PAD patients improved walking ability on ramipril
Ramipril improved ability to walk in patients with peripheral artery disease and intermittent claudication, a new study found.
Editor's Note: The study discussed in this item has been retracted by its authors. The retraction notice is online.
Ramipril improved ability to walk in patients with peripheral artery disease and intermittent claudication, a new study found.
The trial randomized 212 Australians with peripheral artery disease (mean age, 65.5) to 24 weeks of treatment with 10 mg of ramipril per day or placebo. At the start and end of treatment, they were given a standard treadmill test, the Walking Impairment Questionnaire (WIQ) and the Short-Form 36 Health Survey (SF-36). Results appeared in the Feb. 6 Journal of the American Medical Association.
Compared to the placebo group, ramipril was associated with a 75-second increase in mean pain-free walking time (95% CI, 60 to 89 seconds) and a 255-second increase in maximum walking time (95% CI, 215 to 295 seconds). The ramipril patients also had significantly greater improvements in their WIQ scores for median distance, speed and stair climbing. There was also a significant increase in their physical functioning, according to the SF-36.
The improvements in walking found in this study were greater than those reported with the conventional therapies for peripheral artery disease, the authors said. They noted that angiotensin-converting enzyme (ACE) inhibition has not been specifically recommended for intermittent claudication and that this is the first trial to demonstrate improved walking performance with ramipril. They also acknowledged that their study excluded patients for a number of factors, including poorly controlled hypertension and other major comorbid conditions, so the generalizability of the results is not clear.
An accompanying editorial noted that the study population was limited to Australian citizens and the results need to be confirmed in ethnically diverse populations, since variations in the ACE genotype might affect response. The editorialist also pointed out that prior trials of ramipril, as well as other ACE inhibitors, for this application have had mixed results, and that the mechanism of action is unclear.