Ramipril helps reduce claudicationBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f731 (Published 06 February 2013) Cite this as: BMJ 2013;346:f731
Few effective drug treatments are available for intermittent claudication, so a successful trial of ramipril has been given a cautious welcome by researchers from Australia. In a placebo controlled trial, older adults taking the angiotensin converting inhibitor were able to walk on a treadmill for 255 seconds longer than controls (95% CI 215 to 295; P<0.001). They could walk for longer without pain and had higher scores on self reported measures of walking speed, walking distance, and stair climbing. All the differences were big enough to be noticeable clinically and were associated with significant improvement in the physical component of a well established quality of life instrument (short form 36 health survey).
The trial tested 10 mg a day of ramipril for six months in 212 adults with stable intermittent claudication caused by peripheral arterial disease. Participants were otherwise reasonably well. Most were current or ex-smokers. About half had controlled hypertension and a quarter had diabetes. Seven participants developed a persistent cough while taking ramipril and had to withdraw (7/106; 6.6%).
Ramipril seemed to work well in this selection of patients, says a linked editorial (p 487). It is not yet clear how, or whether the benefits extend to other angiotensin converting enzyme inhibitors. Evaluation should continue in more diverse populations. The current most effective treatment, which isn’t widely available, is supervised exercise on a treadmill.
Cite this as: BMJ 2013;346:f731