The study
Australian researchers randomised 212 patients with a history of intermittent claudication to receive either ramipril or a matching placebo. All patients had a resting ankle brachial index of less than 0.90 in at least one leg and a stable medication regimen for the last six months. Pain-free walking time and maximum walking time, as measured by a standard treadmill test, were assessed at six month follow-up.
The findings
Ramipril treatment was associated with a significant 75 second increase in mean pain-free walking time, compared with placebo. Ramipril was also associated with a significant 255 second increase in maximum walking time, compared to placebo. There were also significant reduction in the physical component score of the Short Form 36 questionnaire, improving by 8.2 in the ramipril group compared to placebo.
What does it mean for GPs?
The Australia-based researchers concluded that the findings for ramipril in this study are ‘greater than those reported for other conventional drug therapies,’ including cilostazol and pentoxifylline. They added that these associations were additional to those achieved with standard clinical management by a GP, and that further benefits may be achieved by ‘adherence to lifestyle recommendations.’
Expert comment
Dr Kosta Manis, GP in Bexley and cardiology lead for Bexley Clinical Commissioning Group: ‘Theoretically ramipril should have a beneficial effect on PAD, and a study as far back as 2006 showed that ramipril improved walking ability in patients with PAD, a finding supported by this trial. As a clinician, aware of the fact that there is not any particularly effective treatment for patients with peripheral vascular disease (27 million in Europe and North America alone) and also bearing in mind that ramipril is a relatively inexpensive drug, I would consider it worth trying in selected patients.’
JAMA 2013, available online 6 February
