212 patents average aged 65 years were randomized to 10mg of ramipril and placebo for 24 weeks. Inclusion criteria were ankle brachial index less than 0.9 at least in one leg, history of claudication in unilateral or bilateral legs, stable medication for 24 weeks.
Exclusion criteria were Limiting coronary artery disease, Renal failure (serum creatinine more than 0.20 mmol/L), and Current treatment or treatment within the previous 6 months with ACE inhibitors or angiotensin II receptor antagonists
Constant load Thread meal test with 3.2 km/h and 12% grade was done both at beginning and at end of 6 months. At 6months mean walking distance increased in ramipril group compared to placebo and that was75 -second (95% CI, 60-89 seconds, P less than 0.001) and peak walking distance increased by 255-second (95% CI, 215-295 seconds, P less than 0.001)
The benfit of ramipril was 77% increase in pain-free walking time, a 123% increase in maximum walking time, and a 132% increase in maximum walking distance.
The benfit of ramipril in PAD patients is more than expensive alternatives pentoxifylline and cilostazol.