Brief communication: ramipril markedly improves walking ability in patients with peripheral arterial disease: a randomized trial

Ann Intern Med. 2006 May 2;144(9):660-4. doi: 10.7326/0003-4819-144-9-200605020-00009.


Background: Peripheral arterial disease (PAD) affects up to 12% of adults older than 50 years of age. Conventional therapies have only modest effects in improving symptoms.

Objective: To examine the effects of angiotensin-converting enzyme inhibition on walking ability in patients with PAD.

Design: Randomized, double-blind, placebo-controlled trial initiated in March 2003 and completed in January 2005.

Setting: The Alfred Hospital, Melbourne, Australia.

Participants: 40 older adults with symptomatic PAD and no history of diabetes or hypertension.

Intervention: 10 mg of ramipril (n = 20) or placebo (n = 20) once daily for 24 weeks. All patients completed the trial.

Measurements: Pain-free and maximum walking time were recorded during a standard treadmill test, and the standard Walking Impairment Questionnaire was administered.

Results: After adjustment for the baseline pain-free walking time, mean pain-free walking time after ramipril treatment was 227 seconds (95% CI, 175 seconds to 278 seconds; P < 0.001) longer than that after placebo treatment. Similarly, maximum walking time improved by 451 seconds in the ramipril group (CI, 367 seconds to 536 seconds; P < 0.001) but did not change in the placebo group. Ramipril improved the Walking Impairment Questionnaire median distance score from 5% (range, 1% to 39%) to 21% (range, 12% to 58%; P < 0.001), speed score from 3% (range, 3% to 39%) to 18% (range, 8% to 50%; P < 0.001), and stair-climbing score from 17% (range, 4% to 80%) to 67% (range, 38% to 88%; P < 0.001). No adverse events were reported.

Limitations: The sample size is modest, and the strict inclusion criteria limit the applicability of the results to patients with claudication and infrainguinal disease and those without diabetes.

Conclusion: Ramipril improved pain-free and maximum walking time in some adults with symptomatic PAD.

Trial registration: NCT00168467.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Retracted Publication

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Blood Pressure
  • Double-Blind Method
  • Exercise
  • Female
  • Humans
  • Intermittent Claudication / etiology
  • Intermittent Claudication / prevention & control
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / complications
  • Peripheral Vascular Diseases / drug therapy*
  • Peripheral Vascular Diseases / physiopathology
  • Ramipril / therapeutic use*
  • Regional Blood Flow
  • Surveys and Questionnaires
  • Walking*


  • Angiotensin-Converting Enzyme Inhibitors
  • Ramipril

Associated data