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Ramipril improved treadmill walking times, QOL for patients with PAD
When treated with the ACE inhibitor ramipril, patients with intermittent claudication caused by peripheral arterial disease experienced less pain, increased walking times and improved quality of life after 24 weeks of treatment.
The results are from a randomized, double blind, placebo-controlled trial of 212 patients with PAD (mean age, 65 years). Patients at three hospitals in Australia were randomly assigned ramipril 10 mg/day (n=106) or matching placebo (n=106) for 24 weeks. The primary outcome measures were maximum and pain-free walking times, as recorded during a standard treadmill test. Researchers used the Walking Impairment Questionnaire to measure walking ability and the Short-Form 36 Health Survey to measure QOL.
At 24 weeks, ramipril treatment was associated with an increase in pain-free walking time of 75 seconds and an increase in walking time of 255 seconds (P<.001 for both), relative to placebo. This equates to a 77% and 123% increase in pain-free and maximum walking times, respectively, according to a press release.
“The 77% and 123% increases in pain-free and maximum walking times with ramipril are greater than those reported for other conventional drug therapies … which are associated with increases in treadmill walking distance of no more than 60%,” Anna A. Ahimastos, PhD, of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia, and colleagues wrote in JAMA.
In addition, patients assigned ramipril experienced an improvement in Walking Impairment Questionnaire score of 13.8, speed score of 13.3 and stair climbing score of 25.2. According to the researchers, these increases suggest that ramipril treatment improves patient ability to perform normal daily activities.
The ACE inhibitor was also associated with moderate improvement in the physical health component of the Short-Form-36 score.
“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,” the researchers concluded.
In an accompanying editorial, Mary McGrae McDermott, MD, of the department of medicine at Northwestern University Feinberg School of Medicine, discussed a recent report from the Global Disease of Burden study that showed the global disease burden is shifting toward noncommunicable diseases and to more 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,” she wrote. “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.”
For more information:
Ahimastos AA. JAMA. 2013;309:453-460.
McDermott MM. JAMA. 2013;309:487-488.
Disclosure: See the study for a list of the researchers’ relevant financial disclosures. McGrae McDermott reports serving as the medical editor for PAD for the Foundation for Informed Medical Decision Making and consulting for Ironwood Pharmaceuticals, which is developing drugs to treat PAD.