ACE inhibitors for claudication

Evidence Summaries

Level of Evidence = C
Ramipril may be effective in increasing walking distance in patients with claudication.

An RCT 1 including 40 older adults with symptomatic peripheral arterial disease and no history of diabetes or hypertension compared 10 mg of ramipril with placebo for 24 weeks. All patients had evidence of superficial femoral artery stenosis and an ABI less than 0.9. Patients with type 2 diabetes, limiting coronary artery disease, renal failure, and history of hypertension were excluded. All patients completed the trial. The mean pain-free walking time after ramipril was 227 seconds longer than after placebo (95% CI 175 to 278, p<0.001), and the maximum walking time improved by 451 seconds in the ramipril group (95% CI 367 to 536, p<0.001) but did not change in the placebo group. No adverse events were reported.

Comment: The quality of evidence is downgraded by sparse data and indirectness caused by strict inclusion criteria.


1. Ahimastos AA, Lawler A, Reid CM, Blombery PA, Kingwell BA. 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.  [PMID:16670135]

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